Background: Percutaneous nephrolithotomy (PCNL) remains the
standard treatment for large (>20 mm), staghorn, and complex renal calculi.
Although the prone position has traditionally been preferred, it is associated
with anaesthetic challenges, longer operative times due to repositioning, and
ergonomic limitations. Supine PCNL, particularly in the Galdakao-modified
supine Valdivia position, has re-emerged as an alternative that may improve
perioperative safety, workflow efficiency, and facilitate combined antegrade–retrograde
intrarenal surgery (ECIRS).
Objective: To review the current status of supine PCNL,
focusing on its procedural principles, indications, outcomes, complications,
and comparative effectiveness relative to prone PCNL.
Methods: A narrative review was performed synthesising
evidence from comparative studies, randomised trials, meta-analyses, and large
observational series evaluating supine PCNL. Key aspects analysed included
patient selection, positioning techniques, access and tract creation,
intraoperative workflow, adjunctive ECIRS, anaesthetic and ergonomic
considerations, postoperative strategies, and reported clinical outcomes.
Results: Across most indications, supine PCNL demonstrates
stone-free and complication rates comparable to prone PCNL. Supine positioning
consistently reduces operative and anaesthesia time by eliminating
intraoperative repositioning and improves airway access and hemodynamic
stability, particularly in obese and high-risk patients. ECIRS is more readily
feasible in the supine position, narrowing any potential disadvantage in
complete staghorn calculi. Bleeding, infection, and visceral injury rates are
similar between positions when appropriate patient selection and imaging-guided
access are employed.
Conclusion: Supine PCNL is a safe, efficient, and versatile
alternative to prone PCNL that aligns with contemporary goals of
patient-centred care, anaesthetic safety, and surgical ergonomics. With
appropriate training and case selection, it achieves outcomes equivalent to the
prone approach while offering distinct workflow and physiologic advantages.
Author(s) Details
Bhavyadeep Korrapati
Department of Urology and Renal Transplant, Sri Ramachandra Institute of
Higher Education and Research, Chennai, Tamil Nadu, India.
Vijayanand Mani
Department of Urology and Renal Transplant, Sri Ramachandra Institute of
Higher Education and Research, Chennai, Tamil Nadu, India.
Velmurugan
Palaniyandi
Department of Urology and Renal Transplant, Sri Ramachandra Institute of
Higher Education and Research, Chennai, Tamil Nadu, India.
Hariharasudhan Sekar
Department of Urology and Renal Transplant, Sri Ramachandra Institute of
Higher Education and Research, Chennai, Tamil Nadu, India.
Sriram Krishnamoorthy
Department of Urology and Renal Transplant, Sri Ramachandra Institute of
Higher Education and Research, Chennai, Tamil Nadu, India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH5
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