The new generation super-mini percutaneous nephrolithotomy (SMP) system: a step-by-step guide.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Endourology

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard treatment for kidney stones.
• Existing PCNL systems can involve larger access tracts and potential complications.
• Advancements in endoscopic technology aim to improve safety and efficacy.

Purpose of the Study:

• To present a novel, miniaturized endoscopic system for super-mini percutaneous nephrolithotomy (SMP).
• To provide a step-by-step guide for the successful implementation of the new SMP system.
• To evaluate the safety and efficacy of the new-generation SMP system in patients with renal calculi.

Main Methods:

• A new-generation SMP endoscopic system was utilized, featuring a 40,000-pixel super-mini nephroscope and a unique two-layered irrigation-suction sheath.
• Fifty-nine patients with renal stones underwent the procedure between April 2016 and December 2016, with percutaneous tract dilatation to 14 F.
• Holmium laser or pneumatic lithotripsy was used, with stone fragments removed via vacuum suctioning through the sheath; stone-free status was assessed by low-dose CT.

Main Results:

• The procedure was successfully completed in all 59 patients with a mean operation time of 32.9 minutes.
• The mean stone burden was 2.4 cm, and the overall stone-free rate was 91.5%.
• Complications occurred in 5.1% of patients (Clavien-Dindo Grade I), with no transfusions required.

Conclusions:

• The new-generation super-mini percutaneous nephrolithotomy (SMP) system is safe, feasible, and effective for renal calculi management.
• Advantages include a small percutaneous tract, reduced blood loss, high stone clearance efficacy, improved visual field, and shorter operation times.
• The system offers ease of operation, making it a valuable option for treating kidney stones less than 3 cm.