The "mini-perc" technique: a less invasive alternative to percutaneous nephrolithotomy

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Standard percutaneous nephrolithotomy (PCNL) is associated with significant drawbacks including increased blood loss, pain, and prolonged hospitalization.
• Alternative treatments like ureteroscopy and extracorporeal shock-wave lithotripsy have their own limitations.
• A novel technique is needed to mitigate the adverse effects of traditional PCNL.

Purpose of the Study:

• To evaluate the efficacy and safety of a 13-Fr "mini-perc" technique for percutaneous nephrolithotomy (PCNL).
• To assess if the "mini-perc" approach can reduce complications and recovery time compared to standard PCNL.

Main Methods:

• A 13-Fr "mini-perc" technique utilizing a ureteroscopy sheath was employed for PCNL.
• Nine patients aged 40-73 years with kidney stone burdens ≤ 2 cm² underwent the procedure.
• Data collected included procedure time, blood loss, hematocrit decrease, pain management, hospital stay, and stone-free status.

Main Results:

• The average procedure time was 176 minutes, with an estimated blood loss of 83 ml and a 6.6% hematocrit decrease.
• Patients required an average of 14 mg of parenteral morphine and had a mean hospital stay of 1.7 days.
• Eight of nine kidneys (89%) were stone-free at early follow-up, with no procedure-related complications or transfusions.

Conclusions:

• The 13-Fr "mini-perc" technique demonstrates comparable early stone-free rates to standard PCNL in selected patients.
• This minimally invasive approach may offer significant advantages in reducing hemorrhage, postoperative pain, and hospital stay.
• The "mini-perc" technique represents a promising alternative for managing kidney stones with potentially improved patient outcomes.