Tips and Tricks to Improve Ergonomics, Efficacy, Versatility, and Overcome Limitations of Micro Percutaneous Nephrolithotomy

Abstract

Percutaneous Nephrolithotomy (PCNL) has evolved over the decades from Standard to Mini to Ultramini PCNL to Micro-perc, with miniaturisation being the dominant theme and supine approach gaining momentum world over.Aim: In literature, miniaturised PCNL with microperc needle access system has raised concerns of intrarenal pressure and has some limitations with its success for larger stones. Our tips and tricks explain how to overcome these pitfalls by utilising the full construct of the needle system to its maximum potential. These will in turn help make the procedure versatile, precise, ergonomical, and enhance a surgeon's experience with improved outcomes for patients especially in large renal stones.Materials and Methods: We describe the limitations of microperc needle access as stated in literature and proposals by the co-authors using microperc for miniaturised access on how to overcome the same.Results: A simplified table describing the limitations and tips and tricks on overcoming these is provided for quick reference.Conclusion: As Technological advancements and techniques for miniaturised access in urolithiasis improve, we believe our suggestions will help surgeons overcome the quoted limitations of microperc needle access for miniaturised PCNL, making this a versatile, safe and efficacious technique even in large and complex stones. A multi centre trial will be the best way to validate the suggestions proposed in this article.

Endoscopic Combined Intrarenal Surgery vs Percutaneous Nephrolithotomy for Large and Complex Renal Stone: A Systematic Review and Meta-Analysis

“…Tiny fragments can be flushed through the PCNL sheath or ureteral access sheath (UAS). 55 Based on the findings of this review, there are advantages of ECIRS over PCNL. Apart from the outcomes analyzed in this review, several studies suggest the ease of performing the procedure, including the avoidance of the need for multiple tracts and the improvement of helping decide the need for a ureteral stent or a second-stage procedure.…”

The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis

“…From their side, S. Biligere et al reported the successful experience of a combination of micro-PNL (nephroscope tube size 7-11 Fr) and RIRS. In this combination, percutaneous and retrograde endoscopic accesses to the renal collecting system were also performed, but the evacuation of calculus fragments, in contrast to the mini-PNL, was performed through a retrograde ureteral introducer [49].…”