Lateral percutaneous nephrolithotomy: A safe and effective surgical approach

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PCNL) is standard for large renal calculi, often using the prone position.
• Prone PCNL presents anesthetic challenges, while supine PCNL has ergonomic and puncture-related drawbacks.
• A need exists for improved PCNL positioning to overcome limitations of current methods.

Purpose of the Study:

• To evaluate the feasibility and safety of lateral-PCNL for managing large renal calculi.
• To assess if lateral-PCNL mitigates the disadvantages associated with prone and supine PCNL.
• To determine the efficacy of lateral-PCNL in achieving stone clearance.

Main Methods:

• Retrospective analysis of 347 lateral-PCNL cases performed between July 2001 and July 2015.
• Patients positioned laterally over a bridge with a modified table to create lumbar space.
• Evaluation focused on stone clearance at 3 months, operative time, and complication rates.

Main Results:

• Primary stone clearance was achieved in 82.7% of patients.
• Mean operative time was 97 minutes; tract establishment averaged 4.5 minutes.
• Postoperative complications included fever (13.5%), transfusion (2.3%), and one hydrothorax; no bowel perforations occurred.

Conclusions:

• Lateral-PCNL demonstrates effective stone clearance due to favorable ergonomics.
• The technique is a safe and viable alternative for routine large renal calculus management.
• Lateral-PCNL addresses limitations of traditional prone and supine approaches.