Abstract
At present, PNL is the minimally invasive technique of choice to treat complex renal stones. Despite being a safe surgical intervention, PNL is not exempt from potential complications, which can arise at any stage of the procedure: patient positioning, renal puncture, tract dilation, intraoperative manipulation, stone fragmentation and postoperative management. Besides being the majority of them minor, they can be kept to a minimum in experienced hands with the development of new techniques and improved technologies. However, patient positioning-related complications are not considered in any classification, as well as those related to anaesthesiological problems, which are the ones minimised adopting ECIRS in the Galdakao-modified supine Valdivia position. In particular, with regard to the potential complications due to decubitus, haemodynamic conditions, management of the respiratory tract and the relative location of the colon with respect to the puncture site, PNL performed in supine decubitus or in any of its variations proves to be safer than in prone decubitus.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Langmayr J, Ortler M, Obwegeser A, Felber S (1996) Quadriplegia after lumbar disc surgery. A case report. Spine 21:1932–1935
Anderton J, Schady W, Markham D (1994) An unusual cause of postoperative brachial plexus palsy. J Anaesth 72:605–607
Schwartz D, Drummond D, Hahn M et al (2000) Prevention of positional brachial plexopathy during surgical correction of scoliosis. Spinal Disord 13:178–182
Winfree C, Kline D (2005) Intraoperative positioning nerve injuries. Surg Neurol 63:5–18
Valdivia Uria J, Valle J, Villarroya S et al (1990) Why is percutaneous nephrostomy still performed with patient prone? J Endourol 4:269–272
De Sio M, Autorino R, Quarto G et al (2008) Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access. a prospective randomized trial. Eur Urol 54:196–202
Ibarluzea G, Scoffone C, Cracco C et al (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100: 233–236
Daels F, Gonzalez M, Garcia Freire F et al (2009) Percutaneous lithotripsy in Valdivia-Galdakao decubitus position: our experience. J Endourol 23:1615–1620
Valdivia UrÃa JG, Valle Gerhol J, López López JA (1999) Percutaneous nephroscopy technique in supine position. Braz J Urol 25:263–267
Anderton J (1991) The prone position for the surgical patient: a historical review of the principles and hazards. Br J Anaesth 67:452–463
Jain Y, Bithal P, Rath J (2007) Pressure score on malar prominences by horseshoe headrest in prone position. Anaesth Int Care 35:304–305
Moore D, Edmunds L (1950) Prone position frame. Surgery 27:276–279
Ray C (1987) New kneeling attachment and cushioned face rest for spinal surgery. Neurosurgery 20:266–269
Jericho B, Scaria G (2003) Contact dermatitis after use of the prone positioned. Br Anesth Analg 19:1–4
Kai Y, Yamaoka A, Irita K, Zaitsu A, Takahashi S (1995) Transient tracheal obstruction during surgical correction of scoliosis in a patient with Marfan’s syndrome. Masui 44:868–873
Szabo M, Denman W, Marota J, Roberts J (1997) Evaluation of airway edema in patients operated on in the prone position. J Neurosurg Anaesthesiol 9:380
Cheng M, Todorov A, Templehoff R et al (2001) The effect of prone positioning on intraocular pressure in anesthetized patients. Anaesthesiology 95:1351–1355
Lee L (2003) Postoperative visual loss registry: preliminary analysis of factors associated with spine operations. ASA Newsl 67:7–8
Roth S, Tung A, Ksiazek S (2007) Visual loss in a prone-positioned spine surgery patient with the head on a foam headrest and goggles covering the eyes: an old complication with a new mechanism. Anesth Analg 104:1185–1187
Lee L, Posner K (2006) The American Society of Anaesthesiologists Postoperative visual loss registry: analysis of 93 spine surgery cases with postoperative visual loss. Anaesthesiology 105:652–659
Stevens W, Glazer P, Kelley S et al (1997) Ophthalmic complications after spinal surgery. Spine 22:1319–1322
Palmon S, Kirsch J, Deppe J, Toung T (1998) The effect of the prone position on pulmonary mechanics is frame dependent. Anesth Analg 87:1175–1180
Lee T, Yamg L, Chen H (1998) Effect of patient position and hypotensive anesthesia on inferior vena cava pressure. Spine 23:941–948
Tobias D, Mencio G, Atwood R, Gurwitz G (1994) Intraoperative cardiopulmonary resuscitation in the prone position. J Pediatr Surg 29:1537–1538
Gonzalez MS, Billordo Peres N, Garcia Marchibena P et al (2009) Colon position in ventral and intermediate dorsal decubitus (Valdivia). J Endourol 23(Suppl 1):A49, World Congress of Endourology 2009, abstract MP4-19
Hopper K, Sherman J, Luethke J, Ghaed N (1987) The retrorenal colon in the supine and prone patient. Radiology 162:443–446
LeRoy A, Williams H Jr, Bender C (1985) Colonic perforation following percutaneous nephrostomy and renal calculus removal. Radiology 155:83–85
Gupta R, Kumar A, Kapoor R et al (2002) Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy. BJU Int 90:809–813
Munver R, Delvecchio FC, Newman GE, Preminger GM (2001) Critical analysis of supracostal access for percutaneous renal surgery. J Urol 166:1242–1246
Robert M, Maubon A, Roux JO et al (1999) Direct percutaneous approach to the upper pole of the kidney: MRI anatomy with assessment of the visceral risk. J Endourol 13:17–20
Desai A, Jain S, Benway B et al (2010) Spleen injury during percutaneous nephrolithotomy: a case report with a novel management technique. J Endourol 24:541–545
Valer Algarabel J, Valdivia Uria J, Orozco J et al (1992) Anatomia renal aplicada a la cirugia percutánea, Cuadernos de Endourologia. Hospital Clinico Universitario, Zaragoza
Sampaio F (1992) Anatomic background for intrarenal endourologic surgery. J Endourol 6:301–304
Sampaio F, Zanier J, Aragao A (1992) Intrarenal access: three dimensional anatomical study. J Urol 148:1769–1773
Sampaio F, Aragao A (1990) Anatomical relationship between the intrarenal arteries and the kidney collecting system. J Urol 143:679–681
Koroglu A, Toga T, Cicek M et al (2003) The effects of irrigation fluid volume and irrigation time on fluid electrolyte balance and hemodynamics in percutaneous nephrolithotripsy. Int Urol Nephrol 35:1–6
Rozentsveig V, Neulander E, Roussabrov E et al (2007) Anesthetic considerations during percutaneous nephrolithotomy. J Clin Anesth 19:351–355
Gehring H, Nahm W, Zimmermann K et al (1999) Irrigation fluid absorption during percutaneous nephrolithotripsy. Acta Anaesthesiol Scand 43:316–321
Roberts S, Bolton D, Stoller M (1994) Hypothermia associated with percutaneous nephrolithotomy. Urology 44:832–835
Tefekli A, Altunrende F, Tepeler K et al (2007) Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. Int Urol Nephrol 39:57–63
Shah H, Khandar A, Sodha H et al (2009) Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients. BJU Int 104:840–846
De La Rosette JJ, Zuazu JR, Tsakiris P et al (2008) Prognostic factors and per cutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using the Clavien classification. J Urol 180:2489–2493
Tefekli A, Ali Karadag M, Tepeler K et al (2008) Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol 53:184–190
Zuazu JR, Hruza M, Rassweiler JJ, De Rosette JJ (2010) The Clavien classification system to optimize documentation of PCNL morbidity. Arch Ital Urol Androl 82:20–22
De La Rosette J, Assimos D, Desai M, CROES PCNL Study Group (2011) The Clinical Research Office of the Endourological Society percutaneous nephrolithotomy global study: indications, complications and outcomes in 5,803 patients. J Endourol 25:11–17
Ozden E, Mercimek MN, Yakupoglu YK et al (2011) Modified Clavien classification in percutaneous nephrolithotomy: assessment of complications in children. J Urol 185:264–268
Labate G, Modi P, Timoney A et al (2011) The percutaneous nephrolithotomy global study: classification of complications. J Endourol 25:1275–1280
Seitz C, Desai M, Haecker A et al (2012) Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 61:146–158
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag France
About this chapter
Cite this chapter
Daels, F.P.J., Gonzalez, M.S. (2014). Intraoperative Complications: How to Avoid Them?. In: Scoffone, C., Hoznek, A., Cracco, C. (eds) Supine Percutaneous Nephrolithotomy and ECIRS. Springer, Paris. https://doi.org/10.1007/978-2-8178-0459-0_20
Download citation
DOI: https://doi.org/10.1007/978-2-8178-0459-0_20
Published:
Publisher Name: Springer, Paris
Print ISBN: 978-2-8178-0359-3
Online ISBN: 978-2-8178-0459-0
eBook Packages: MedicineMedicine (R0)