Lateral Percutaneous Nephrolithotomy: An Alternative Approrach
Author(s):
Miss Jasmine Ju Hsien Gan
,
Miss Jasmine Ju Hsien Gan
Affiliations:
Miss Jaslyn Ju Lia Gan
,
Miss Jaslyn Ju Lia Gan
Affiliations:
Mr Jonathan Jian Wei Gan
,
Mr Jonathan Jian Wei Gan
Affiliations:
Mr Kim Tiong Lee
Mr Kim Tiong Lee
Affiliations:
BAUS ePoster online library. Gan J. 06/26/17; 177366; P3-10
Jasmine Ju Hsien Gan
Jasmine Ju Hsien Gan
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Abstract
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Introduction: Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position to remove large renal calculi. However, there are anaesthetic limitations associated with the prone position. The supine position has been suggested, but it is associated with poorer ergonomics due to its awkward downward renal tract, smaller window for percutaneous puncture and higher risks of anterior calyx puncture. The aim in this study is to demonstrate the feasibility of lateral-PCNL in managing large renal calculi without the disadvantages associated with the prone and lateral position.

Methods: A retrospective case series was conducted on 396 lateral PCNL cases by a single surgeon from July 2001 to July 2015. The lateral-PCNL was performed in a unique manner; the patient’s thorax, abdomen and pelvis were positioned over a bridge perpendicular to the ‘broken’table, creating an extended lumbodorsal space. The procedure was evaluated in terms of its learning curve, secondary stone clearance at 3 months post procedure, and complications.

Results: Primary stone clearance was achieved in 82.7% of patients. Subsequent procedures were performed post-primary procedure in 74 patients with residual stones. Secondary stone clearance was achieved in 91% of patients with non-staghorn stones, and 73% of patients with staghorn stones. The learning curve of this procedure was 15 cases. 2% of patients required post-operative transfusion and 12.6% of patients had post operative fever. There was 1 case of hydrothorax, no bowel perforation.

Conclusion: Our lateral-PCNL technique allows for effective stone clearance due to superior stone ergonomics, and is safe even in most routine procedures.
Introduction: Percutaneous nephrolithotomy (PCNL) is traditionally performed with the patient in the prone position to remove large renal calculi. However, there are anaesthetic limitations associated with the prone position. The supine position has been suggested, but it is associated with poorer ergonomics due to its awkward downward renal tract, smaller window for percutaneous puncture and higher risks of anterior calyx puncture. The aim in this study is to demonstrate the feasibility of lateral-PCNL in managing large renal calculi without the disadvantages associated with the prone and lateral position.

Methods: A retrospective case series was conducted on 396 lateral PCNL cases by a single surgeon from July 2001 to July 2015. The lateral-PCNL was performed in a unique manner; the patient’s thorax, abdomen and pelvis were positioned over a bridge perpendicular to the ‘broken’table, creating an extended lumbodorsal space. The procedure was evaluated in terms of its learning curve, secondary stone clearance at 3 months post procedure, and complications.

Results: Primary stone clearance was achieved in 82.7% of patients. Subsequent procedures were performed post-primary procedure in 74 patients with residual stones. Secondary stone clearance was achieved in 91% of patients with non-staghorn stones, and 73% of patients with staghorn stones. The learning curve of this procedure was 15 cases. 2% of patients required post-operative transfusion and 12.6% of patients had post operative fever. There was 1 case of hydrothorax, no bowel perforation.

Conclusion: Our lateral-PCNL technique allows for effective stone clearance due to superior stone ergonomics, and is safe even in most routine procedures.
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