Flank free modified supine position: A new modification for supine percutaneous nephrolithotomy

Area of Science:

• Urology
• Nephrolithiasis Management
• Surgical Positioning

Background:

• Percutaneous nephrolithotomy (PCNL) is standard for large or complex kidney stones.
• Current patient positioning for PCNL (prone or supine) has drawbacks and limitations.
• Optimal patient positioning for PCNL remains an area for improvement.

Purpose of the Study:

• To describe a modified supine position for PCNL.
• To evaluate if this modified position overcomes limitations of the standard supine approach.
• To provide easy surgical access comparable to the prone position.

Main Methods:

• Prospective study of 78 patients undergoing PCNL at Zagazig University, Egypt.
• Patients were positioned supine, then in a 'flank-free modified' supine position.
• Measurement of the distance between the last rib and iliac crest in the posterior axillary line for both positions.

Main Results:

• The flank-free modified supine position increased the rib-iliac crest distance by a mean of 12 mm.
• This modification, without flank cushioning, offers ample space for surgical procedures.
• Mean patient age was 40.8 years, mean stone diameter 3.4 cm, mean BMI 28.8 kg/m².

Conclusions:

• The flank-free modified supine position enhances surgical space for PCNL.
• This technique facilitates puncture, dilatation, multiple tracts, and nephroscope maneuverability.
• The modified position offers an advantageous alternative for PCNL procedures.