Use of a Novel Flexible Mini-nephroscope in Minimally Invasive Percutaneous Nephrolithotomy
Dilip Kumar Mishra1, Madhu Sudan Agrawal1
1Department of Urology, Global Rainbow Healthcare, Agra, India.
Objective:
To assess the feasibility and safety of a novel flexible mini-nephroscope in minimally invasive percutaneous nephrolithotomy (PCNL). Presumably, limiting the size and number of tracts during PCNL has the potential of decreasing the morbidity of the procedure. We present our experience with this new technique.
Materials And Methods:
A retrospective analysis of patients with multiple kidney stones treated with mini-PCNL combined with a novel flexible mini-nephroscope was performed. Minimally invasive PCNL was done with rigid 12 F MIP-M nephroscope, followed by flexible mini-nephroscopy for smaller stones in other inaccessible calyces. Record was made of the operating time, stone-free rates, postoperative pain, morbidity, hospital stay, time to recovery, complication rates, and ancillary procedures. Matched-pair analysis was done with cases operated by flexible ureteroscopy performed with Flex X-2 or Flex X-c scope.
Results:
Twenty-five patients in the study group were matched with 25 cases from the flexible ureteroscopy group. Both groups were comparable in terms of age, laterality, and mean composite stone burden. The mean operating time was 40.1 ± 10.6 minutes in the mini-PCNL group and 51.2 ± 8.8 minutes in the flexible ureteroscopy group. Mean hospital stay was similar in both groups. The primary stone clearance rate of 92% (23 of 25) in the mini-PCNL group was better than the clearance rate of 80% (20 of 25) in the flexible ureteroscopy group. Eight percent in the mini-PCNL group required ancillary procedures as compared with 20% of cases in the flexible ureteroscopy group. Postoperative pain and analgesia requirement in these patients was minimal. There were no significant complications.
Conclusion:
Flexible mini-nephroscope is an effective adjuvant to minimally invasive PCNL in achieving high clearance rate with minimum morbidity.
Insights
A novel flexible mini-nephroscope enhances minimally invasive percutaneous nephrolithotomy (PCNL) for kidney stones. This technique offers a higher stone clearance rate with reduced complications and minimal patient morbidity.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithotomy
Background:
- Minimally invasive percutaneous nephrolithotomy (PCNL) aims to reduce procedure morbidity by limiting tract size and number.
- Novel flexible instruments may further enhance the efficacy and safety of minimally invasive PCNL.
Purpose of the Study:
- To evaluate the feasibility and safety of a new flexible mini-nephroscope for minimally invasive PCNL.
- To compare the outcomes of mini-PCNL using the novel scope with standard flexible ureteroscopy.
Main Methods:
- Retrospective analysis of 25 patients undergoing mini-PCNL with a flexible mini-nephroscope for multiple kidney stones.
- Procedures involved initial rigid nephroscopy followed by flexible mini-nephroscopy for inaccessible stones.
- Matched-pair analysis compared outcomes with 25 patients treated with flexible ureteroscopy.
Main Results:
- Mini-PCNL group showed a higher primary stone clearance rate (92%) compared to flexible ureteroscopy (80%).
- Operating time was shorter in the mini-PCNL group (40.1 min vs. 51.2 min).
- Fewer ancillary procedures were needed in the mini-PCNL group (8% vs. 20%), with minimal postoperative pain and no significant complications.
Conclusions:
- The flexible mini-nephroscope is effective as an adjunct to minimally invasive PCNL.
- This approach achieves high stone clearance rates with minimal morbidity.
- The technique demonstrates feasibility and safety in treating complex kidney stone burdens.
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