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      Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique

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          Abstract

          Endoscopic combined intrarenal surgery (ECIRS) with simultaneous retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) has been proposed as a new surgical treatment to overcome the disadvantage of RIRS and PCNL monotherapies in the treatment of renal stone. One of advantages of ECIRS is that it can increase stone-free rates in complex renal stone within single-session. Intermediate-supine position in real-time simultaneous ECIRS can prevent an anesthesiologic problem, and patient's burden is small even for long-term operation. Thus, we will share the experience and advantages of real-time simultaneous ECIRS and introduce techniques to increase the stone-free rate.

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          Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy?

          R. Scarpa, Susanna Grande, Viola C. Scoffone … (2008)
          Percutaneous nephrolithotomy (PCNL), the gold standard for the management of large and/or complex urolithiasis, is conventionally performed with the patient in the prone position, which has several drawbacks. Of the various changes in patient positioning proposed over the years, the Galdakao-modified supine Valdivia (GMSV) position seems the most beneficial. It allows simultaneous performance of PCNL and retrograde ureteroscopy (ECIRS, Endoscopic Combined Intra-Renal Surgery) and has unquestionable anaesthesiological advantages. To prospectively analyse the safety and efficacy of endoscopic combined intrarenal surgery (ECIRS) in GMSV position for the treatment of large and/or complex urolithiasis. From April 2004 to December 2007, 127 consecutive patients who were followed in our department for large and/or complex urolithiasis were selected for surgery (American Society of Anesthesiologists [ASA] score 1-3, no active urinary tract infection [UTI], any body mass index [BMI]). All the patients underwent ECIRS in GMSV position. Technical choices about percutaneous access, endoscopic instruments and accessories, and postoperative renal and ureteral drainage are detailed. Patients' mean age plus or minus standard deviation (+/- SD) was 53.1 yr+/-14.2. Of the 127 patients, 5.5% had congenital renal abnormalities, 3.9% had solitary kidneys, and 60.6% were symptomatic for renal colics, haematuria, and recurrent UTI. Mean stone size+/-SD was 23.8mm+/-7.3 (range: 11-40); 33.8% of the calculi were calyceal, 33.1% were pelvic, 33.1% were multiple or staghorn, and 4.7% were also ureteral. Mean operative time+/-SD was 70min+/-28, including patient positioning. Stone-free rate was 81.9% after the first treatment and was 87.4% after a second early treatment using the same percutaneous access during the same hospital stay (mean+/-SD: 5.1 d+/-2.9). We registered overall complications at 38.6% with no splanchnic injuries or deaths and no perioperative anaesthesiological problems. ECIRS performed in GMSV position seems to be a safe, effective, and versatile procedure with a high one-step stone-free rate, unquestionable anaesthesiological advantages, and no additional procedure-related complications.
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            Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access.

            Adrien Tempia-Caliera, Mikel Gamarra, Gaspar Ibarluzea … (2007)
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              Endoscopic combined intrarenal surgery for large calculi: simultaneous use of flexible ureteroscopy and mini-percutaneous nephrolithotomy overcomes the disadvantageous of percutaneous nephrolithotomy monotherapy.

              Shuzo Hamamoto, Takahiro Yasui, Atsushi Okada … (2014)
              Percutaneous nephrolithotomy (PCNL) is considered the standard procedure for the removal of large renal calculi. The development of the "minimally invasive PCNL" (mini-PCNL) has reduced the complications of the surgery; it also appears to be associated with less morbidity than the conventional PCNL (con-PCNL). This study aimed at evaluating the efficacy of endoscopic intrarenal surgery, using the prone-split leg position, using flexible ureteroscopy and mini-PCNL (mini- endoscopic combined intrarenal surgery [ECIRS]) by retrospectively comparing this technique with mini-PCNL and con-PCNL.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Investig Clin Urol
                Journal ID (iso-abbrev): Investig Clin Urol
                Journal ID (publisher-id): ICU
                Title: Investigative and Clinical Urology
                Publisher: The Korean Urological Association
                ISSN (Print): 2466-0493
                ISSN (Electronic): 2466-054X
                Publication date (Print): September 2018
                Publication date (Electronic): 16 July 2018
                Volume: 59
                Issue: 5
                Pages: 348-354
                Affiliations
                [1 ]Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea.
                [2 ]Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
                [3 ]Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Joo Yong Lee. Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. TEL: +82-2-2228-2320, FAX: +82-2-312-2538, joouro@ 123456yuhs.ac
                Author information
                https://orcid.org/0000-0002-3470-1767
                Article
                DOI: 10.4111/icu.2018.59.5.348
                PMC ID: 6121022
                PubMed ID: 30182081
                SO-VID: c430cf28-c510-4d10-9524-6e9fb4f5b74c
                Copyright © © The Korean Urological Association, 2018
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 April 2018
                Date accepted : 18 June 2018
                Funding
                Funded by: Yonsei University College of Medicine, CrossRef http://dx.doi.org/10.13039/501100008005;
                Award ID: 6-2016-0119
                Categories
                Subject: Innovations in Urology

                Keywords: kidney,nephrolithiasis,ureteroscopy,urinary calculi
                Data availability:
                Keywords: kidney, nephrolithiasis, ureteroscopy, urinary calculi

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