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WCE 2019: Ultra-mini-PERC Under Local Anesthesia: A Novel Approach in Select Cases

Abu Dhabi, United Arab Emirates (UroToday.com) Mini-perc and super-min-perc are two surgical techniques that have successfully decreased the size of renal access catheters and sheaths to 14Fr, ultimately allowing for the expansion of percutaneous nephrolithotomy (PCNL) to a wider patient population. This morning, Dr. Charbel Chalouhy, presented his research which examined the safety and efficacy of ultra-mini-perc, a novel technique using anterograde flexible ureteroscopy through a 10Fr renal access catheter under local anesthesia.   He explained that the ultra-mini-perc technique is usually employed for high-risk patients who have difficult undergoing general anesthesia and who have more complex lower tract anatomy.

In his study, Dr. Chalouhy and his team recruited patients who were considered at a higher risk for undergoing general or spinal anesthesia who were undergoing percutaneous flexible ureteroscopy as an alternative to standard RIRS or PCNL. Rather than perform these more standard procedures on these patients, Dr. Chalouhy introduced a 10Fr renal access catheter under local anesthesia using fluoroscopic and ultrasound guidance. The goal of his study was to determine whether this ultra-mini-perc surgical approach through a 10Fr access sheath under local anesthesia was a safe and efficient means of attenuating stone burdens.

The results demonstrated that, for their small patient cohort, that ultra-mini-perc, when compared to standard PCNL and mini-perc procedures, translated to similar operative times and a lower stone-free rate of around 77%. Because of the already high-risk patient cohort that were deemed suitable for the ultra-mini-perc procedure due to their high risk for undergoing general anesthesia, the average hospital stay for these patients was prolonged up to 11 days.

Presented by: Charbel Chalouhy, MD, Urology-Transplant surgeon, Saint Joseph University, Baltimore, Maryland

Written by Andrew Shea Afyouni, BS, Junior Research Specialist and Medical Student, University of California, Irvine Department of Urology at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates