A new keyhole surgery method for kidney stones
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
Dr Tanuj Paul Bhatia