Optimizing stone harvesting in miniaturized-PCNL: a critical examination of renal access angles, technology, and the role they play in operative efficiency

Springer Science and Business Media LLC - Tập 41 - Trang 1943-1949 - 2023
Kenneth Schmanke1, Willian Ito1, Dillon Prokop2, Brandon Kannady2, Mihaela Sardiu3, Bristol Whiles1, Donald Neff1, David Duchene1, Wilson Molina1
1Department of Urology, The University of Kansas Health System, Kansas City, USA
2School of Medicine, The University of Kansas, Kansas City, USA
3Department of Biostatistics and Data Science, University of Kansas, Kansas City, USA

Tóm tắt

Stone retrieval can be a laborious aspect of percutaneous nephrolithotomy (PCNL). A unique phenomenon of mini-PCNL is the vortex-effect (VE), a hydrodynamic form of stone retrieval. Additionally, the vacuum‐assisted sheath (VAS) was recently developed as a new tool for stone extraction. The purpose of our study is to investigate the impact of renal access angle (as a surrogate for patient positioning) on stone retrieval efficiency and compare the efficiency among methods of stone retrieval. A kidney model was filled with 3 mm artificial stones. Access to the mid‐calyx was obtained using a 15Fr sheath. Stones were retrieved over three minutes at angles of 0°, 25°, and 75° utilizing the VE, VAS, and basket. Stones were weighed for comparison of stones/retraction and stones/minute. Trials were repeated three times at each angle. Renal access angle of 0° was associated with increased stone retrieval for both the VE and VAS (p < 0.05). The VE was the most effective method for stones retrieved per individual retraction at an angle of 0° (p < 0.005), although when analyzed as stones retrieved per minute, the VE and VAS were no longer statistically different (p = 0.08). At 75°, none of the methods were statistically different, regardless if analyzed as stones per retraction or per minute (p = 0.20‐0.40). Renal access angle of 0° is more efficient for stone retrieval than a steep upward angle. There is no difference in stone retrieval efficiency between the VE and VAS methods, although both are superior to the basket at lower sheath angles.

Tài liệu tham khảo

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