Vacuum-assisted versus conventional percutaneous sheaths in pediatric supine mini-PCNL: a comparative analysis

Vacuum-assisted access sheaths have recently gained interest in percutaneous stone surgery; however, data regarding their use in pediatric patients remain limited. This study compared the perioperative and postoperative outcomes of vacuum-assisted and conventional percutaneous access sheaths in pediatric patients undergoing supine mini-percutaneous nephrolithotomy. Medical records of children younger than 18 years who underwent supine mini-percutaneous nephrolithotomy between January 2022 and January 2026 were retrospectively reviewed. Patients with anatomical anomalies, bilateral procedures, multiple access tracts, or endoscopic combined intrarenal surgery were excluded. A total of 51 patients were included and divided into two groups according to sheath type: conventional percutaneous access sheaths (n = 27) and vacuum-assisted ClearPetra sheaths (n = 24). Baseline demographic and stone characteristics were comparable between the groups. Mean operative time was shorter in the vacuum-assisted group (57.6 ± 21 vs. 65.6 ± 24 min, p = 0.232), whereas fluoroscopy time was slightly longer (74.2 ± 65 vs. 60.6 ± 44 s, p = 0.387); neither difference reached statistical significance. Stone-free rates were comparable between the conventional and vacuum-assisted groups (85.2% vs. 91.7%, p = 0.473). Overall complication rates were low and similar (25.9% vs. 16.7%, p = 0.541). A lower rate of postoperative fever was observed in the vacuum-assisted group; however, this difference did not reach statistical significance (4.2% vs. 18.5%, p = 0.112). All cases resolved with medical treatment. No aspiration-related morbidity was observed. No statistically significant differences in operative or postoperative outcomes were observed between vacuum-assisted access using the ClearPetra sheath and conventional access sheaths in pediatric patients undergoing supine mini-percutaneous nephrolithotomy. Larger prospective studies are needed to determine whether vacuum-assisted access provides clinically meaningful advantages.