Vacuum-assisted access sheath in supine mini-percutaneous nephrolithotomy (mini-PCNL)

Area of Science:

• Urology
• Surgical Technology
• Nephrolithiasis Treatment

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard procedure for kidney stone removal.
• Mini-PCNL utilizes smaller scopes and instruments for less invasive stone extraction.
• Vacuum-assisted PCNL (Va-PCNL) is an emerging technique employing continuous irrigation and vacuum dynamics for enhanced stone fragment removal.

Purpose of the Study:

• To compare the stone-free rate (SFR) and complication profiles of Va-PCNL versus standard mini-PCNL.
• To evaluate the impact of Va-PCNL on operative time and postoperative recovery.

Main Methods:

• A retrospective study included 136 patients undergoing either Mini-PCNL or Va-PCNL between January 2018 and June 2022.
• Va-PCNL was performed using a disposable sheath with continuous high-flow irrigation and vacuum fluid dynamics.
• Surgical outcomes, including SFR, operative time, complication rates, and hospital stay, were collected and compared.

Main Results:

• Mean operative time was significantly shorter for Va-PCNL (95 min) compared to Mini-PCNL (146 min).
• The tubeless technique was more frequent in the Va-PCNL group (61.4% vs. 34.2%).
• No significant differences in postoperative complications or 3-month SFR were observed between the groups (Va-PCNL: 71.9%, Mini-PCNL: 71.8%).
• Mean hospital stay was significantly lower for Va-PCNL (1.7 days) versus Mini-PCNL (2.7 days).

Conclusions:

• Va-PCNL demonstrates comparable stone-free rates and infectious complication profiles to Mini-PCNL.
• Va-PCNL offers potential advantages, including reduced operative time and shorter hospital stays.
• The vacuum-assisted approach represents a promising advancement in minimally invasive kidney stone treatment.