Percutaneous nephrolithotomy (PCNL) is usually performed in standard prone, semisupine, flank, or complete supine (csPCNL) position. Correct patient positioning is mandatory to facilitate the procedure and prevent complications. When compared with other positions, the csPCNL offers the potential advantages of less patient handling, the need to drape only once, less risk of colon injury, and the ability to perform simultaneous PCNL and ureteroscopic procedures. If PCNL is performed initially with spinal or regional anesthesia and general anesthesia is needed, the change is easier in this position. The supine position allows better access to the airway and may be less hazardous than other positions, especially for patients with compromised cardiopulmonary function, morbid obesity, or those who require a prolonged procedure. There is better drainage with the Amplatz sheath, and stone fragment evacuation is facilitated. The benefits of ultrasound-guided PCNL include no exposure to radiation for the patient or operating room staff, no need for dye materials, and no chance for injury to the surrounding tissues and organs. In ultrasound-guided PCNL, all of the tissues between the skin and kidney can be visualized directly. The present authors performed csPCNL with a subcostal upper-pole puncture and found that the kidney is situated lower than it is located in the prone position. As a result, access to the upper pole is feasible and associated with less complication. Overall, csPCNL is safe, effective, and suitable for most patients. Literature on csPCNL, imaging modalities, tract creation, tubless PCNL, and mini-PCNL is reviewed.
Siavash Falahatkar
KEYWORDS: Percutaneous nephrolithotomy; Supine surgical position; Sonography; Imaging; Body mass index (BMI); Upper pole access
CORRESPONDENCE: Siavash Falahatkar M.D., Guilan University of Medical Sciences, Urology Research Center, Razi Hospital, Sardare Jangal Street, Rasht, Guilan 41448, Iran ( ).
CITATION: UroToday Int J. 2010 Apr;3(2).
doi: 10.3834/uij.1944-5784.2010.04.03