Abstract
Percutaneous nephrolithotomy (PCNL) is today accepted as the first-choice technique when managing complex renal stones. When taking into consideration the retroperitoneal position of the kidney, its relationship with other organs, and its own particular vascular distribution, the safest access to the urinary tract appears to be through a posterior calyx papilla, and the approach will always be through the lumbar area of the patient. Therefore, traditionally, the patient has been placed in the prone position. Nevertheless, other decubitus positions have been used for patients (supine, Valdivia-Galdakao, and intermediate supine).
Despite these different alternatives, intermediate supine decubitus has been demonstrated to be, in our experience, simpler, safer, and more versatile. Patient placement is simple; joint and pressure point lesions are avoided; hemodynamic and respiratory conditions are preserved; air tract control is guaranteed; bowel is moved away from the puncture site; simultaneous antegrade and retrograde endoscopic and laparoscopic access is possible; excellent lumbar area exposure is obtained; an endourological friendly horizontal or slightly descendent puncture is achieved, plus it provides an excellent anatomic puncture reference (the end of the 12th rib). For all these reasons, intermediate supine decubitus is our first choice when simple PCNL is to be performed and becomes essential when confronting complex cases as it allows a rational minimally invasive combined approach.
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Daels, F.P.J. (2013). Percutaneous Nephrolithotomy (PCNL): The Supine Approach – Overcoming the Difficulties. In: Al-Kandari, A., Desai, M., Shokeir, A., Shoma, A., Smith, A. (eds) Difficult Cases in Endourology. Springer, London. https://doi.org/10.1007/978-1-84882-083-8_15
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