A new key­hole surgery method for kid­ney stones

Hindustan Times (Gurugram) - City - - LIFESTYLE -

Kid­ney stone dis­ease is a very com­mon prob­lem in In­dia. And hence there has been evo­lu­tion in the stone re­moval tech­niques based on the po­si­tion and oc­cur­rence of the stones.

While kid­ney stones were re­moved by open surgery in past, then lithotripsy in­tro­duced fol­lowed by per­cu­ta­neous or key­hole pro­ce­dures and transurethral no-cut pro­ce­dures like RIRS (Ret­ro­grade In­trarenal Surgery) be­came part of the mod­ern day kid­ney stone treat­ment.

While a ma­jor­ity of pa­tients opt for the in­no­va­tive scar­less RIRS pro­ce­dure to­day, there are in­ci­dents when kid­ney stones are big enough or the po­si­tion of the stone in kid­ney re­quires the key-hole pro­ce­dure called PCNL (Per-cu­ta­neous Nephrolitho­tomy).

Con­ven­tional PCNL is done with a small cut on the back keep­ing the pa­tient ly­ing on his ab­domen, un­der gen­eral anaes­the­sia, which in med­i­cal terms is called prone po­si­tion. This be­comes chal­leng­ing for the anaes­thetist to mon­i­tor the pa­tient as air­way of the pa­tient is not eas­ily ac­ces­si­ble. Also, there is a con­tin­u­ous pres­sure on the ab­domen due to which higher ven­ti­la­tor pres­sure has to be used which can cause some da­m­age to the lungs, es­pe­cially in obese pa­tients.

Obe­sity has reached the level of epi­demic in In­dia and prevalance of kid­ney stones in obese per­sons is more com­mon. The sit­u­a­tion be­comes chal­leng­ing for doc­tors as well as the pa­tient to use the RIRS and Prone PCNL po­si­tion to re­move the stones. Here comes the ad­van­tage of ‘Supine PCNL’, a new tech­nique of PCNL pro­ce­dure, pi­o­neered in Europe.

In Supine-PCNL, while un­der gen­eral anaes­the­sia, pa­tient lies on his back like most ab­dom­i­nal surg­eries. The pa­tient is placed in the litho­tomy po­si­tion. This greatly im­proves anaes­thetic man­age­ment by fa­cil­i­tat­ing ventilation and main­te­nance of cir­cu­la­tion in com­par­i­son to the con­ven­tional PCNL by elim­i­nat­ing pres­sure on the face and thus re­duc­ing oph­thalmic com­pli­ca­tions con­se­quent to in­creased in­traoc­u­lar pres­sure. Thus, pa­tient’s air­way is eas­ily ac­ces­si­ble to the anaes­thetist and there is no pres­sure on pa­tient’s chest and ab­domen, mak­ing the pro­ce­dure much safer for the pa­tient.

At our In­sti­tute of Laser Uro­log­i­cal Surgery at Sar­vo­daya Hos­pi­tal and Re­search Cen­tre, headed by Dr Tanuj Paul Bha­tia, we have led the way by adapt­ing to newer tech­niques which are safer for our pa­tients. We have suc­cess­fully per­formed Supine-PCNL in 11 pa­tients so far with ex­cel­lent re­sults. This tech­nique also al­lows us to ac­cess whole of col­lect­ing sys­tem of kid­ney by en­abling both RIRS and PCNL at the same time. Also, we use the newer tech­nique of MiniPCNL in most of our pa­tients, which in­volves a smaller cut and lesser bleed­ing.

We have found the supine po­si­tion for PCNL to be a safe and ef­fec­tive choice for treat­ment of large or com­plex re­nal stones. In our opin­ion, it re­duces oper­a­tive time and ra­di­a­tion ex­po­sure.

The au­thor of the ar­ti­cle, Dr Tanuj Paul Bha­tia is a Sr Con­sul­tant, In­sti­tute of Laser Uro­log­i­cal Surg­eries Sar­vo­daya Hos­pi­tal & Re­search Cen­tre, Farid­abad 9643408039

PHO­TOS: HTCS/SHUT­TER­STOCK

Dr Tanuj Paul Bha­tia

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