Split-leg percutaneous nephrolithotomy: a safe and versatile technique

Area of Science:

• Urology
• Nephrolithiasis Management
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is the standard treatment for kidney stones exceeding 2 cm.
• Patient positioning during PCNL is a subject of ongoing surgical debate.
• The split-leg variant of prone PCNL (SL-PCNL) offers a novel approach.

Purpose of the Study:

• To evaluate the efficacy and safety of the prone split-leg percutaneous nephrolithotomy (SL-PCNL) technique.
• To assess the applicability of SL-PCNL in complex renal stone cases and anatomical abnormalities.

Main Methods:

• A prospective study involving 30 consecutive patients undergoing prone SL-PCNL.
• Preoperative stone burden assessed by CT scan longest diameter or sum of diameters for multiple stones.
• Data collected on patient demographics, stone characteristics, operative time, and outcomes.

Main Results:

• High stone-free rates of 87% after the first procedure and 97% after a second look.
• Average surgical time was 90 minutes with a mean hemoglobin drop of 1.5 mg/dl.
• No major complications were reported; the technique proved versatile for challenging anatomies.

Conclusions:

• Prone SL-PCNL is a versatile technique for percutaneous nephrolithotomy.
• It offers advantages comparable to supine PCNL while accommodating anatomical abnormalities and complex cases.
• The technique is suitable for multi-tract access requirements and challenging stone burdens.