Complete stone clearance using a modified supine position: initial experience and comparison with prone percutaneous...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithotomy

Background:

• The Galdakao-modified supine Valdivia position for PCNL is gaining popularity.
• Further modifications to the supine position have been developed.
• This study compares recent experience with the modified supine position to previous prone PCNL cases.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified supine position for PCNL.
• To compare outcomes of PCNL in the modified supine position versus the traditional prone position.

Main Methods:

• A modified supine position using a suction beanbag was implemented for all PCNL patients starting April 2011.
• Data collected included patient demographics, stone size, operative time, radiation exposure, complications, stone clearance, and length of stay.
• Outcomes were compared to a historical cohort of patients who underwent prone PCNL.

Main Results:

• The supine group had larger stones (32.6 vs 25.7 mm) and shorter operative times (86.2 vs 116.6 min) compared to the prone group.
• Stone clearance rates, length of stay (2.5 days), and complication rates were similar between the two positions.
• Radiation dose was higher in the supine group, though radiation time was similar.

Conclusions:

• The modified supine position for PCNL presents benefits for both patients and staff.
• This technique allows for reduced operative time and maintained stone clearance, even in patients with larger stones and higher BMI.
• Simultaneous access to the lower urinary tract for procedures like ureteroscopy is a significant advantage, aiding complete stone clearance.