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Positioning in Percutaneous Renal Surgery

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Percutaneous Renal Surgery

Abstract

The most important aspect when planning a percutaneous access to treat kidney stones is the selection of the access site to the kidney. Since it was first described, PCNL was traditionally done with the patient in prone, with good success, few complications, and few limitations. As PCNL become more widely used, surgeons have developed alternate patient positions for PCNL, mainly the supine and supine-modified positions. Overall, both approaches have a number of advantages and drawbacks, but are both feasible and acceptable alternatives to access the kidney during percutaneous renal surgery with similar outcomes and rate of complications.

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References

  • Altschuler J, Jain R, Ganesan V, Monga M. Supracostal upper pole endoscopic-guided prone tubeless “maxi-percutaneous nephrolithotomy”: a contemporary evaluation of complications. J Endourol. 2019;33:274–8.

    Article  PubMed  Google Scholar 

  • Astroza G, Lipkin M, Neisius A, Preminger G, De Sio M, Sodha H, Saussine C, de la Rosette J, CROES PNL Study Group. Effect of supine vs prone position on outcomes of percutaneous nephrolithotomy in staghorn calculi: results from the Clinical Research Office of the Endourology Society Study. Urology. 2013;82(6):1240–4.

    Google Scholar 

  • Atkinson CJ, Turney BW, Noble JG, Reynard JM, Stoneham MD. Supine vs prone percutaneous nephrolithotomy: an anaesthetist’s view. BJU Int. 2011;108:306–8.

    Article  PubMed  Google Scholar 

  • Baard J, Kamphuis GM, Westendarp M, de la Rosette JJ. How well tolerated is supine percutaneous nephrolithotomy? Curr Opin Urol. 2014;24(2):184–8.

    Article  PubMed  Google Scholar 

  • Bach C, Goyal A, Kumar P, Kachrilas S, Papatsoris AG, Buchholz N, Masood J. The Barts ‘flank-free’ modified supine position for percutaneous nephrolithotomy. Urol Int. 2012;89(3):365–8.

    Google Scholar 

  • Batagello CA, Barone Dos Santos HD, Nguyen AH, Alshara L, Li J, Marchini GS, Vicentini FC, Torricelli FCM, Danilovic A, Pereira JG, Rose E, Srougi M, Nahas WC, Mazzucchi E, Monga M. Endoscopic guided PCNL in the prone split-leg position versus supine PCNL: a comparative analysis stratified by Guy’s stone score. Can J Urol. 2019;26(1):9664–74.

    Google Scholar 

  • Cracco CM, Scoffone CM. ECIRS (endoscopic combined intrarenal surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery? World J Urol. 2011;29:821–7.

    Article  PubMed  Google Scholar 

  • De Sio M, Autorino R, Quarto G, Calabrò F, Damiano R, Giugliano F, Mordente S, D’Armiento M. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol. 2008;54(1):196–202.

    Article  PubMed  Google Scholar 

  • Duty B, Waingankar N, Okhunov Z, Ben Levi E, Smith A, Okeke Z. Anatomical variation between the prone, supine, and supine oblique positions on computed tomography: implications for percutaneous nephrolithotomy access. Urology. 2012;79:67–71.

    Article  PubMed  Google Scholar 

  • Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth. 2008;100(2):165–83.

    Article  CAS  PubMed  Google Scholar 

  • Falahatkar S, Moghaddam AA, Salehi M, Nikpour S, Esmaili F, Khaki N. Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique. J Endourol. 2008;22(11):2513–7.

    Article  PubMed  Google Scholar 

  • Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10(3):257–9.

    Google Scholar 

  • Gattinoni L, Caironi P. Prone positioning: beyond physiology. Anesthesiology. 2010;113(6):1262–4.

    Article  PubMed  Google Scholar 

  • Giusti G, Proietti S, Rodríguez-Socarrás ME, Eisner BH, Saitta G, Mantica G, Villa L, Salonia A, Montorsi F, Gaboardi F. Simultaneous bilateral endoscopic surgery (SBES) for patients with bilateral upper tract urolithiasis: technique and outcomes. Eur Urol. 2018;74(6):810–5.

    Article  PubMed  Google Scholar 

  • Grasso M, Nord R, Bagley DH. Prone split leg and flank roll positioning: simultaneous antegrade and retrograde access to the upper urinary tract. J Endourol. 1993;7(4):307–10.

    Article  CAS  PubMed  Google Scholar 

  • Hopper KD, Sherman JL, Luethke JM, Ghaed N. The retrorenal colon in the supine and prone patient. Radiology. 1987;162(2):443–6.

    Article  CAS  PubMed  Google Scholar 

  • Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, Astobieta A, Camargo I, Gamarra M, Tempia A, Valdivia Uria JG, Scarpa RM. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int. 2007;100(1):233–6.

    Article  PubMed  Google Scholar 

  • Jones DJ, Russell GL, Kellett MJ, Wickham JE. The changing practice of percutaneous stone surgery. Review of 1000 cases 1981–1988. Br J Urol. 1990;66(1):1–5.

    Google Scholar 

  • Karami H, Arbab AH, Rezaei A, Mohammadhoseini M, Rezaei I. Percutaneous nephrolithotomy with ultrasonography-guided renal access in the lateral decubitus flank position. J Endourol. 2009;23(1):33–5. https://doi.org/10.1089/end.2008.0433.

    Article  PubMed  Google Scholar 

  • Khoshrang H, Falahatkar S, Ilat S, Akbar MH, Shakiba M, Farzan A, Herfeh NR, Allahkhah A. Comparative study of hemodynamics electrolyte and metabolic changes during prone and complete supine percutaneous nephrolithotomy. Nephrourol Mon. 2012;4(4):622–8.

    Google Scholar 

  • Li J, Gao L, Li Q, Zhang Y, Jiang Q. Supine versus prone position for percutaneous nephrolithotripsy: a meta-analysis of randomized controlled trials. Int J Surg. 2019;66:62–71.

    Article  PubMed  Google Scholar 

  • Liu L, Zheng S, Xu Y, Wei Q. Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in the supine versus prone position. J Endourol. 2010;24:1941–6.

    Article  PubMed  Google Scholar 

  • Manohar T, Jain P, Desai M. Supine percutaneous nephrolithotomy: effective approach to high-risk and morbidly obese patients. J Endourol. 2007;21(1):44–9.

    Article  CAS  PubMed  Google Scholar 

  • Mazzucchi E, Vicentini FC, Marchini GS, Danilovic A, Brito AH, Srougi M. Percutaneous nephrolithotomy in obese patients: comparison between the prone and total supine position. J Endourol. 2012;26:1437–42.

    Google Scholar 

  • Papatsoris AG, Zaman F, Panah A, Masood J, El-Husseiny T, Buchholz N. Simultaneous anterograde and retrograde endourologic access: “the Barts technique.” J Endourol. 2008;22(12):2665–6.

    Article  PubMed  Google Scholar 

  • Perrella R, Vicentini FC, Paro ED, Torricelli FCM, Marchini GS, Danilovic A, Batagello CA, Mota PKV, Ferreira DB, Cohen DJ, Murta CB, Claro JFA, Giusti G, Monga M, Nahas WC, Srougi M, Mazzucchi E. Supine versus prone percutaneous nephrolithotomy for complex stones: a multicenter randomized controlled trial. J Urol. 2022;207(3):647–56.

    Article  PubMed  Google Scholar 

  • Proietti S, de la Rosette J, Eisner B, Gaboardi F, Fiori C, Kinzikeeva E, Luciani L, Miano R, Porpiglia F, Rosso M, Sofer M, Traxer O, Giusti G. Bilateral endoscopic surgery for renal stones: a systematic review of the literature. Minerva Urol Nefrol. 2017;69(5):432–45.

    PubMed  Google Scholar 

  • Proietti S, Pavia MP, Rico L, Basulto-Martinez M, Yeow Y, Contreras P, Galosi A, Gaboardi F, Giusti G. Simultaneous bilateral endoscopic surgery: is it ready for prime time? J Endourol. 2022;36:1155–60.

    Article  PubMed  Google Scholar 

  • Proietti S, Rodríguez-Socarrás ME, Eisner B, De Coninck V, Sofer M, Saitta G, Rodriguez-Monsalve M, D’Orta C, Bellinzoni P, Gaboardi F, Giusti G. Supine percutaneous nephrolithotomy: tips and tricks. Transl Androl Urol. 2019;8(Suppl 4):S381–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Proietti S, Sortino G, Giannantoni A, Sofer M, Peschechera R, Luciani LG, Morgia G, Giusti G. Single-session supine bilateral percutaneous nephrolithotomy. Urology. 2015;85(2):304–9.

    Google Scholar 

  • Ray AA, Chung DG, Honey RJ. Percutaneous nephrolithotomy in the prone and prone-flexed positions: anatomic considerations. J Endourol. 2009;23(10):1607–14.

    Article  PubMed  Google Scholar 

  • Sanguedolce F, Breda A, Millan F, Brehmer M, Knoll T, Liatsikos E, Osther P, Traxer O, Scoffone C. Lower pole stones: prone PCNL versus supine PCNL in the International Cooperation in Endourology (ICE) group experience. World J Urol. 2013;31(6):1575–80.

    Article  PubMed  Google Scholar 

  • Scarpa RM, Cossu FM, De Lisa A, Porru D, Usai E. Severe recurrent ureteral stricture: the combined use of an anterograde and retrograde approach in the prone split-leg position without X-rays. Eur Urol. 1997;31(2):254–6.

    Article  CAS  PubMed  Google Scholar 

  • Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol. 2008;54:1393–403.

    Article  PubMed  Google Scholar 

  • Segura JW, Patterson DE, LeRoy AJ, Williams HJ Jr, Barrett DM, Benson RC Jr, May GR, Bender CE. Percutaneous removal of kidney stones: review of 1000 cases. J Urol. 1985;134(6):1077–81.

    Article  CAS  PubMed  Google Scholar 

  • Sofer M, Giusti G, Proietti S, Mintz I, Kabha M, Matzkin H, Aviram G. Upper Calyx approachability through a lower calyx access for prone versus supine percutaneous nephrolithotomy. J Urol. 2016;195(2):377–82.

    Article  PubMed  Google Scholar 

  • Telias I, Katira BH, Brochard L. Is the prone position helpful during spontaneous breathing in patients with COVID-19? JAMA. 2020;323(22):2265–7.

    Article  CAS  PubMed  Google Scholar 

  • Tsaturyan A, Vrettos T, Ballesta Martinez B, Liourdi D, Lattarulo M, Liatsikos E, Kallidonis P. Position-related anesthesiologic considerations and surgical outcomes of prone percutaneous nephrolithotomy: a review of the current literature. Minerva Urol Nephrol. 2022;74(6):695–702.

    PubMed  Google Scholar 

  • Valdivia JG, Scarpa RM, Duvdevani M, Gross AJ, Nadler RB, Nutahara K, de la Rosette JJ, Croes PCNL Study Group. Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol. 2011;25(10):1619–25.

    Google Scholar 

  • Valdivia JG, Valer J, Villarroya S, Lopez JA, Bayo A, Lanchares E, Rubio E. Why is percutaneous nephroscopy still performed with the patient prone? J Endourol. 1990;4(3):209–77.

    Google Scholar 

  • Valdivia Uría JG, Lachares Santamaría E, Villarroya Rodríguez S, Taberner Llop J, Abril Baquero G, Aranda Lassa JM. Nefrolitectomía percutánea: técnica simplificada (nota previa) [Percutaneous nephrolithectomy: simplified technic (preliminary report)]. Arch Esp Urol. 1987;40(3):177–80.

    PubMed  Google Scholar 

  • Valdivia Uría JG, Valle Gerhold J, López López JA, Villarroya Rodriguez S, Ambroj Navarro C, Ramirez Fabián M, Rodriguez Bazalo JM, Sánchez Elipe MA. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol. 1998;160(6 Pt 1):1975–8.

    PubMed  Google Scholar 

  • Wang Y, Wang Y, Yao Y, Xu N, Zhang H, Chen Q, Lu Z, Hu J, Wang X, Lu J, Hao Y, Jiang F, Hou Y, Wang C. Prone versus modified supine position in percutaneous nephrolithotomy: a prospective randomized study. Int J Med Sci. 2013;10(11):1518–23.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yazici CM, Kayhan A, Dogan C. Supine or prone percutaneous nephrolithotomy: do anatomical changes make it worse? J Endourol. 2014;28(1):10–6.

    Article  PubMed  Google Scholar 

  • Yuan D, Liu Y, Rao H, Cheng T, Sun Z, Wang Y, Liu J, Chen W, Zhong W, Zhu J. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol. 2016;30(7):754–63.

    Article  PubMed  Google Scholar 

  • Zhan HL, Li ZC, Zhou XF, Yang F, Huang JF, Lu MH. Supine lithotomy versus prone position in minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi. Urol Int. 2013;91(3):320–5.

    Article  PubMed  Google Scholar 

  • Zhang X, Xia L, Xu T, Wang X, Zhong S, Shen Z. Is the supine position superior to the prone position for percutaneous nephrolithotomy (PCNL)? Urolithiasis. 2014;42(1):87–93.

    Article  PubMed  Google Scholar 

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Correspondence to Guido Giusti .

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Gutierrez-Aceves, J., Ho, L., Proietti, S., Pupulin, M., Di Pietro, S., Giusti, G. (2023). Positioning in Percutaneous Renal Surgery. In: Denstedt, J.D., Liatsikos, E.N. (eds) Percutaneous Renal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-40542-6_6

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  • DOI: https://doi.org/10.1007/978-3-031-40542-6_6

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