Lateral percutaneous nephrolithotomy: A safe and effective surgical approach

Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of th...

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Published inIndian journal of urology Vol. 34; no. 1; pp. 45 - 50
Main Authors Wei Gan, Jonathan Jian, Lia Gan, Jaslyn Ju, Hsien Gan, Jasmine Ju, Lee, Kim Tiong
Format Journal Article
LanguageEnglish
Published India Medknow Publications and Media Pvt. Ltd 01.01.2018
Medknow Publications & Media Pvt. Ltd
Medknow Publications & Media Pvt Ltd
Wolters Kluwer Medknow Publications
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Abstract Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of the renal tract, a smaller window for percutaneous puncture, and a higher risk of anterior calyx puncture. This study aimed to demonstrate the feasibility and safety of lateral-PCNL in managing large renal calculi without the disadvantages of prone and supine positions. Retrospectively, 347 lateral-PCNL cases performed from July 2001 to July 2015 were examined. the patient's thorax, abdomen, and pelvis were positioned over a bridge perpendicular to a "broken" table, creating an extended lumbodorsal space. The procedure was evaluated in terms of stone clearance at 3 months' postprocedure, operative time, and complications. Primary stone clearance was achieved in 82.7% of patients. The mean operating time was 97 min. The average time taken to establish the tract and mean radiation time were 4.5 min and 6.93 min, respectively. In total, 2.3% of patients required postoperative transfusion, and 13.5% of patients had postoperative fever. There was one case of hydrothorax, but no bowel perforation. Our lateral-PCNL technique allows for effective stone clearance due to good stone ergonomics and it should be considered as a safe alternative even in the most routine procedures.
AbstractList Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of the renal tract, a smaller window for percutaneous puncture, and a higher risk of anterior calyx puncture. This study aimed to demonstrate the feasibility and safety of lateral-PCNL in managing large renal calculi without the disadvantages of prone and supine positions. Retrospectively, 347 lateral-PCNL cases performed from July 2001 to July 2015 were examined. the patient's thorax, abdomen, and pelvis were positioned over a bridge perpendicular to a "broken" table, creating an extended lumbodorsal space. The procedure was evaluated in terms of stone clearance at 3 months' postprocedure, operative time, and complications. Primary stone clearance was achieved in 82.7% of patients. The mean operating time was 97 min. The average time taken to establish the tract and mean radiation time were 4.5 min and 6.93 min, respectively. In total, 2.3% of patients required postoperative transfusion, and 13.5% of patients had postoperative fever. There was one case of hydrothorax, but no bowel perforation. Our lateral-PCNL technique allows for effective stone clearance due to good stone ergonomics and it should be considered as a safe alternative even in the most routine procedures.
INTRODUCTIONPercutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of the renal tract, a smaller window for percutaneous puncture, and a higher risk of anterior calyx puncture. This study aimed to demonstrate the feasibility and safety of lateral-PCNL in managing large renal calculi without the disadvantages of prone and supine positions. METHODSRetrospectively, 347 lateral-PCNL cases performed from July 2001 to July 2015 were examined. the patient's thorax, abdomen, and pelvis were positioned over a bridge perpendicular to a "broken" table, creating an extended lumbodorsal space. The procedure was evaluated in terms of stone clearance at 3 months' postprocedure, operative time, and complications. RESULTSPrimary stone clearance was achieved in 82.7% of patients. The mean operating time was 97 min. The average time taken to establish the tract and mean radiation time were 4.5 min and 6.93 min, respectively. In total, 2.3% of patients required postoperative transfusion, and 13.5% of patients had postoperative fever. There was one case of hydrothorax, but no bowel perforation. CONCLUSIONSOur lateral-PCNL technique allows for effective stone clearance due to good stone ergonomics and it should be considered as a safe alternative even in the most routine procedures.
Introduction: Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations exist with the prone position. Similarly, the supine position is associated with poorer ergonomics due to the awkward downward position of the renal tract, a smaller window for percutaneous puncture, and a higher risk of anterior calyx puncture. This study aimed to demonstrate the feasibility and safety of lateral-PCNL in managing large renal calculi without the disadvantages of prone and supine positions. Methods: Retrospectively, 347 lateral-PCNL cases performed from July 2001 to July 2015 were examined. the patient's thorax, abdomen, and pelvis were positioned over a bridge perpendicular to a "broken" table, creating an extended lumbodorsal space. The procedure was evaluated in terms of stone clearance at 3 months' postprocedure, operative time, and complications. Results: Primary stone clearance was achieved in 82.7% of patients. The mean operating time was 97 min. The average time taken to establish the tract and mean radiation time were 4.5 min and 6.93 min, respectively. In total, 2.3% of patients required postoperative transfusion, and 13.5% of patients had postoperative fever. There was one case of hydrothorax, but no bowel perforation. Conclusions: Our lateral-PCNL technique allows for effective stone clearance due to good stone ergonomics and it should be considered as a safe alternative even in the most routine procedures.
Audience Academic
Author Hsien Gan, Jasmine Ju
Wei Gan, Jonathan Jian
Lee, Kim Tiong
Lia Gan, Jaslyn Ju
AuthorAffiliation 1 University College London Medical School, London WC1E 6BT, UK
2 Department of Urology, Puteri Specialist Hospital, Johor Bahru, Malaysia
Department of Urology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
AuthorAffiliation_xml – name: 1 University College London Medical School, London WC1E 6BT, UK
– name: Department of Urology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
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  surname: Wei Gan
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– sequence: 2
  givenname: Jaslyn Ju
  surname: Lia Gan
  fullname: Lia Gan, Jaslyn Ju
  organization: University College London Medical School, London WC1E 6BT, UK
– sequence: 3
  givenname: Jasmine Ju
  surname: Hsien Gan
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  givenname: Kim Tiong
  surname: Lee
  fullname: Lee, Kim Tiong
  organization: Department of Urology, Puteri Specialist Hospital, Johor Bahru, Malaysia
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29343912$$D View this record in MEDLINE/PubMed
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Cites_doi 10.1080/21681805.1976.11882084
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Snippet Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic limitations...
Introduction: Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However,...
INTRODUCTIONPercutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position for large renal calculi. However, anesthetic...
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StartPage 45
SubjectTerms Anesthesia
Care and treatment
Hospitals
Kidney stones
Original
Patients
Percutaneous nephrostomy
Safety and security measures
Surgeons
Surgery
Surgical outcomes
Systematic review
University colleges
Urine
Urogenital system
Urology
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Title Lateral percutaneous nephrolithotomy: A safe and effective surgical approach
URI https://www.ncbi.nlm.nih.gov/pubmed/29343912
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Volume 34
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