The Barts 'flank-free' modified supine position for percutaneous nephrolithotomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithotomy

Background:

• Supine positions for percutaneous nephrolithotomy (PCNL) have evolved, each with unique advantages and limitations.
• Existing supine techniques present challenges in image-guided puncture, operative field access, multiple tract creation, and integration with retrograde intrarenal surgery (RIRS).
• A need exists for an improved supine position that overcomes these limitations.

Purpose of the Study:

• To describe and illustrate a novel flank-free modified supine position for PCNL.
• To evaluate the efficacy and benefits of this new position in addressing existing challenges in supine PCNL.

Main Methods:

• Description of a newly developed flank-free modified supine position.
• Illustration of the surgical technique and patient positioning.
• Comparison with established supine and prone PCNL positions.

Main Results:

• Facilitates easy percutaneous access with minimal torso tilt (15°).
• Provides ample space for multiple tract placement and dilation due to a neutral kidney position.
• Enables a horizontal tract for lower intrarenal pressures, efficient fragment washout, and familiar RIRS integration, with improved patient comfort due to less torso rotation.

Conclusions:

• The flank-free modified supine position demonstrates encouraging results comparable to other established PCNL positions.
• This technique offers significant advantages in terms of access, tract management, and combined procedures.
• The Barts 'flank-free' modified supine position is proposed as a new standard for supine PCNL.