"Flank suspended" supine percutaneous nephrolithotomy for high-risk and obese patients

Objective To investigate the clinical significance of percutaneous nephrolithotomy(PCNL) technique in a new supine position,flank suspended,for obese patients with compromised cardiopulmonary status.Methods 20 patients,including 10 males and 10 females,underwent PCNL in a new supine position with epidural anesthesia.The average age was(55.3±10.7) years,and the average size of the stones was(2.72±1.05) cm.12 patients had an anesthesia risk of Grade 3 ASA,and other 8 patients were obese.With all patients placed in a new supine position,under ultrasound guidance,the desired calix or pelvis was punctured near the posterior auxiliary line,then the tract was dilated and the 16F or 20F tract for PCNL was established.Results Pelvicaliceal system could be successfully approached in all patients who were well tolerant.Mean operation time was(87.90±34.98) minutes.80% of the patients were rendered stone free after the initial PCNL.4 cases(20%) had residual stones,2 of which received a second PCNL to clear the residual stones.None of the patients required blood transfusion or suffered visceral injury.Conclusion The new supine PCNL is a safe and effective procedure for obese and high-risk patients.