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Complete Supine PCNL

Siavash Falahatkar
Endourology Urolaparascopy
Urology Research Center ,  Guilan University of Medical Sciences
csPCNL ,  supine position

Summary

We perform PCNL as a well-known surgical procedure in the complete supine position without any towel under the patient’s flank, and with no change in the leg position. PCNL in the supine position is an effective and safe method for urinary stones. There are numerous advantages for PCNL, including decreasing operating time, evacuation of stone fragment, a more tolerable position for high-risk patients, and sitting position for the surgeon.At the present time, PCNL is either performed in the complete supine, semi supine, lateral or prone position. Although supine PCNL has numerous advantages and is routine in some surgical centers throughout the world, its popularity in the field of Urology, as a whole, is still minimal. This lack of general acceptance is most likely stems from fear of colonic injury during this procedure and also, a deficiency in training of supine PCNL in central education centers. Supine position has numerous advantages, but it is not familiar by most of the endourologists. Benefits of Supine PCNL 1) No need to change position; 2) Ability to perform ureteroscopy during PCNL; 3) Easier air way control by the anesthesiologist; 4) Easier PCNL of the upper calyceal stones; 5) Evacuation of stone fragments; 6) Decreasing operating time; 7) No contact between the patient’s skin and water, which would prevent hypothermia; 8) Less kidney displacement; 9) Less retrorenal colon injury; 10) More comfortable for corpulent or obese patients, and the patients with respiratory or cardiac problems. There are numerous advantages for the endourologist in performing PCNL in the supine position: 1) The fluoroscopy tube is far from the working space. 2) Lack of overlapping of the vertebrae with the kidney. 3) Decreasing the total operating time. 4) Sitting position for the surgeon. Supine PCNL is safe, effective, and suitable for most of the patients, and is feasible for all types of stones, such as calyceal, pelvic, multiple, staghorn, or upper pole calyceal stones.

Main Description

At the present time, PCNL is either performed in the complete supine, semi supine, lateral or prone position. Although supine PCNL has numerous advantages and is routine in some surgical centers throughout the world, its popularity in the field of Urology, as a whole, is still minimal. This lack of general acceptance is most likely stems from fear of colonic injury during this procedure and also, a deficiency in training of supine PCNL in central education centers. Supine position has numerous advantages, but it is not familiar by most of the endourologists. Benefits of Supine PCNL 1) No need to change position; 2) Ability to perform ureteroscopy during PCNL; 3) Easier air way control by the anesthesiologist; 4) Easier PCNL of the upper calyceal stones; 5) Evacuation of stone fragments; 6) Decreasing operating time; 7) No contact between the patient’s skin and water, which would prevent hypothermia; 8) Less kidney displacement; 9) Less retrorenal colon injury; 10) More comfortable for corpulent or obese patients, and the patients with respiratory or cardiac problems. There are numerous advantages for the endourologist in performing PCNL in the supine position: 1) The fluoroscopy tube is far from the working space. 2) Lack of overlapping of the vertebrae with the kidney. 3) Decreasing the total operating time. 4) Sitting position for the surgeon. Supine PCNL is safe, effective, and suitable for most of the patients, and is feasible for all types of stones, such as calyceal, pelvic, multiple, staghorn, or upper pole calyceal stones.

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