scholarly journals The Matryoshka technique in percutaneous nephrolithotomy

2021 ◽  
Vol 93 (2) ◽  
pp. 162-166
Author(s):  
Stefano Paolo Zanetti ◽  
Matteo Fontana ◽  
Elena Lievore ◽  
Matteo Turetti ◽  
Fabrizio Longo ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Colon Perforation ◽  
Blood Transfusions ◽  
Postoperative Fever ◽  
Main Indication ◽  
Percutaneous Access ◽  
Multistep Procedure ◽  
Stone Characteristics ◽  
Median Operative Time

Objective: Miniaturized percutaneous nephrolithotomy (PCNL) reduces the risk of haemorrhagic complications, but the limited field of work represents a drawback. To obtain the best outcomes, the percutaneous access size should be intraoperatively tailored. Our purpose is to describe the indications and the procedural steps of the Matryoshka technique and to report its clinical outcomes. Materials and methods: We performed a retrospective analysis of the data from consecutive Matryoshka PCNL procedures from October 2016 to January 2018. Collected data included patients’ history, stone characteristics, intra- and post-operative items, stone clearance and need for retreatment. The main indication to the Matryoshka technique is the inability to securely position a guidewire due to an obstruction or narrowness in the pyelocalyceal system. This technique begins by puncturing the calyx hosting the stone and advancing a hydrophilic guidewire through the needle. If the guidewire cannot proceed beyond the stone, the Matryoshka technique is employed for tract stabilization. The tract is carefully dilated with small-bore instruments and a cautious lithotripsy is performed to create enough space to introduce the guidewire beyond the stone under visual control. Once the access has been stabilized the surgeon can upsize the tract to the optimum to complete the procedure. Additionally, the technique can be employed when an intraoperative reassessment induces the surgeon to further dilate the tract to quicken the procedure. Results: Sixteen patients were included, with a median stone volume of 3.49 cm3. Median operative time was 112 minutes. Three Clavien I-II (postoperative fever) and one Clavien IIIB (colon perforation) complications were reported. No blood transfusions were recorded. Three patients underwent scheduled retreatment as part of a multistep procedure. Out of the remaining 13 patients, 10 (76.9%) obtained a complete stone clearance.Conclusions: The Matryoshka technique helps the urologist to obtain a secure percutaneous access and makes PCNL flexible and progressive, potentially minimizing the risk of access-related complications.

Perioperative Blood Transfusions or Operative Time: Which Drives Post-Hepatectomy Outcomes?

2021 ◽  
pp. 000313482199866
Author(s):  
Alexander M. Fagenson ◽  
Henry A. Pitt ◽  
Kwan N. Lau
Keyword(s):  
Operative Time ◽  
Blood Transfusions ◽  
Improvement Program ◽  
Surgical Quality ◽  
Hepatobiliary Cancer ◽  
American College Of Surgeons ◽  
Multivariable Regression ◽  
Logistic Regressions ◽  
Prolonged Operative Time ◽  
Median Operative Time

Background Perioperative blood transfusions and operative time are surgical quality indicators. The aim of this analysis is to determine which of these variables drives post-hepatectomy outcomes. Methods Patients undergoing major or partial hepatectomy were identified in the 2014-2018 American College of Surgeons National Surgical Quality Improvement Program hepatectomy targeted database. Prolonged operative time was defined as ≥ 240 minutes. Multivariable logistic regressions were performed for multiple postoperative outcomes. Results Of 20 521 hepatectomies, 18% of patients received a perioperative transfusion, and the median operative time was 218 minutes. Patients receiving a transfusion had a significant ( P < .001) increase in mortality (5.1% vs. .7%) and serious morbidity (43% vs. 16%). Prolonged operative time was associated with significantly ( P < .001) increased mortality (2.4% vs. .8%) and serious morbidity (29% vs. 14%). Those with primary hepatobiliary cancer had the highest rates of postoperative morbidity and mortality compared to patients with metastatic and benign disease when a transfusion occurred. On multivariable regression analyses, perioperative transfusions conferred a higher risk ( P < .001) than prolonged operative time for mortality (OR 5.02 vs. 1.47) and serious morbidity (OR 2.56 vs. 1.50). Conclusions Perioperative blood transfusions are a more robust predictor of post-hepatectomy outcomes than increased operative time, especially in patients with primary hepatobiliary cancer.

scholarly journals Tract Size in Percutaneous Nephrolithotomy (PCNL) : Does It Really Matter?

2020 ◽  
Vol 18 (2) ◽  
pp. 18-22
Author(s):  
Mofizur Rahman ◽  
Mohammed Monowar Ul Hoque ◽  
Kazi Md Monwarul Karim ◽  
AKM Akramul Bari ◽  
Tanvir Rahman ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Statistical Difference ◽  
Pain Perception ◽  
Operative Time ◽  
Previous History ◽  
Postoperative Fever ◽  
Stone Clearance ◽  
Significant Difference

Background : Percutaneous Nephrolithotomy (PCNL) is the treatment of choice in removal of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study is to compare the safety and efficacy of PCNL using different tract size. Materials and methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Minior Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chittagong from July 2016 to June 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, total operative time, need for blood transfusion, postoperative pain and other complications. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 64 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini- PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.64 ± 0.94 cm and 2.776 ± 0.97 cm in standard-PCNL group. Mean tract size was 18.44 ± 1.32 F (16-20) and 26.7 ± 5 F (24-30) respectively. In mini-PCNL operative time was significantly longer than that of standard PCNL with 110.31 ± 21.77 vs 95.94 ± 19.82 min respectively. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.25 vs. 0.8 ± 0.34) gram and hospital stay (2.13 ± 0.79 vs.3.38 ± 1.13 days) respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.7% vs. 93.33%). There was no statistical difference in terms of Visual Analogue Scale (VAS) score (5.44 ± 1.5 vs.6.19 ± 1.65) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10% vs 13.6%). No statistical difference was recorded in terms of postoperative fever (³38oC) between two groups (2 in each group, 6.67%, p=1). Blood transfusion requirement was much less in mini PCNL group (10% vs. 33.33%). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct to standard PCNL, URS and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 18-22

scholarly journals Infective complications after percutaneous nephrolithotomy in relation to preoperative urine culture status

2019 ◽  
Vol 6 (1) ◽  
pp. 8-13
Author(s):  
Birendra Kumar Yadav ◽  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parish Mani Shrestha
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Operation Time ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Stone Characteristics ◽  
Negative Urine Culture ◽  
Infective Complications

Introductions: Fever and sepsis after percutaneous nephrolithotomy (PCNL) secondary to urinary tract infection is a major determinant of overall post PCNL complications. This study aims to analyse infective complications after PCNL in relation to pre-operative urine culture status. Methods: A comparative analysis of post PCNL infective complications in pre-operative urine culture positive (Group A) and negative (Group B) was done for one year during June 2017 to May 2018 in department of urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. Demographics, stone characteristics, mean operative time, post-operative hospital stay and post-operative complications as per Modified Clavien classification were compared between the two groups. Results: Out of total 136 PCNL patients, 51 were in Group A and 85 in Group B. Infective complications were significantly high, 28 (54.90%) in group A compared to 20 (23.53%) in group B, p=0.004. The most common isolate was Escherichia coli 19 (37.25%), sensitive to amikacin 37 (72.55%). The mean operation time, transfusion and hospital stay was not statically different in two groups. Morality occurred in 1 (1.96%) in group A. Conclusions: Infective complications were significantly high after PCNL in patients with preoperative positive urine culture, even when it was treated to sterile with sensitive antibiotics, compared to patients with preoperative negative urine culture.

scholarly journals MP75-18 COMPARISON OF COSTS AND OUTCOMES OF PERCUTANEOUS NEPHROLITHOTOMY BASED ON PERCUTANEOUS ACCESS

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Rutveej Patel ◽  
Kushan Radadia ◽  
Christopher Han ◽  
Ephrem Olweny ◽  
Sammy Elsamra
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Percutaneous Access

scholarly journals An unusual presentation of colon perforation following percutaneous nephrolithotomy

2014 ◽  
Vol 8 (11-12) ◽  
pp. 862 ◽  
Author(s):  
Barbara Chubak ◽  
Joshua M Stern
Keyword(s):  
Sore Throat ◽  
Percutaneous Nephrolithotomy ◽  
Current Literature ◽  
Signs And Symptoms ◽  
Bowel Injury ◽  
Unusual Presentation ◽  
Diagnosis And Treatment ◽  
Colon Perforation ◽  
Tubeless Pcnl ◽  
Prompt Diagnosis

Colon perforation is a rare but serious complication of percutaneous nephrolithotomy (PCNL), meriting particular attention to its signs and symptoms for prompt diagnosis and treatment. We report an unusual presentation of colon perforation following tubeless PCNL, characterized by sore throat, pneumomediastinum, and neck and shoulder crepitus. In addition to the details of this case, we review the current literature on bowel injury during PCNL and its management.

scholarly journals Lithotrites and Postoperative Fever: Does Lithotrite Type Matter? Results from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

2013 ◽  
Vol 91 (3) ◽  
pp. 340-344 ◽  
Author(s):  
David I. Chu ◽  
Michael E. Lipkin ◽  
Agnes J. Wang ◽  
Michael N. Ferrandino ◽  
Glenn M. Preminger ◽  
...  
Keyword(s):  
Clinical Research ◽  
Percutaneous Nephrolithotomy ◽  
Postoperative Fever ◽  
Global Study ◽  
Research Office

Segment IV Approach is Useful for Whole-Layer Laparoscopic Cholecystectomy for Gallbladder Polyps

2021 ◽  
Author(s):  
Yoshiaki Tanji ◽  
Shuichi Fujioka ◽  
Hironori Shiozaki ◽  
Yuki Takano ◽  
Naoto Takahashi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Malignant Neoplasms ◽  
Pathological Findings ◽  
Gallbladder Polyps ◽  
Cystic Plate ◽  
Potentially Malignant ◽  
Proof Procedure ◽  
Median Operative Time

Abstract Background Whole-layer laparoscopic cholecystectomy (W-LC) has recently been advocated as a total biopsy for potentially malignant neoplasms of the gallbladder; however, it is not an injury-proof procedure. This study reports W-LC using the segment IV approach (technique for securing the whole-layer gallbladder at the medial origin of the cystic plate).MethodsTwenty among twenty-five patients diagnosed with potentially malignant gallbladder polyps underwent this technique.ResultsMostly, W-LC was performed successfully (median operative time 135 min) without intraoperative and postoperative complications. Pathological findings indicated that cholesteric polyps was the most common type (n=13), followed by adenomatous polyps (25%) and carcinoma in situ (5%).ConclusionsWe conclude that the segment IV approach is appropriate for performing total biopsy in patients diagnosed with potentially malignant gallbladder polyps.

Retrograde intrarenal surgery or percutaneous nephrolithotomy in the treatment of impacted proximal ureteric calculi

2021 ◽  
Author(s):  
Lvwen zhang ◽  
Xiang Fei ◽  
Yan Song
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Surgical Outcomes ◽  
Perioperative Period ◽  
Total Treatment Cost ◽  
Retrograde Intrarenal Surgery ◽  
Ureter Stone ◽  
Surgical Safety ◽  
Ureteric Calculi ◽  
Safety Parameters ◽  
Stone Characteristics

Abstract The objective of this study was to compare the clinical efficacy of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of impacted proximal ureteric calculi. This was a retrospective study on surgical outcomes of 202 patients with impacted proximal ureteric calculi. Overall, 140 and 62 were treated with RIRS and PCNL, respectively. The effects of the choice of the surgical method on the surgical outcomes were evaluated by preoperatively scoring patients with high-risk factors related to stone characteristics and analyzing these scores. Compared to the RIRS group, the surgical duration of the PCNL group was significantly shorter (51.69 ± 25.07 min vs. 67.46 ± 27.12 min, p < 0.05), stone-free rate (SFR) was significantly increased (98.4% vs. 72.10%, p < 0.05), and total treatment cost was lower (US $1678.61 ± 714.86 vs. US $3901.45 ± 1069.46, p < 0.05). Preoperatively, the efficacy of PCNL was higher than that of RIRS based on the higher scores observed. The results indicated PCNL had a better SFR and higher surgical efficacy, whereas RIRS had higher surgical safety parameters, a shorter perioperative period, but a lower initial SFR. PCNL is often more advantageous for complicated impacted proximal ureter stone.

Establishment of Predictive Model for Related Factors of Systemic Inflammatory Response Syndrome (SIRS) After Percutaneous Nephrolithotomy (PCNL)

2020 ◽  
Author(s):  
Min Ju ◽  
Jin Zheng ◽  
li Ying Pan ◽  
lin Lin Gao
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Univariate Analysis ◽  
Infection Process ◽  
Systemic Inflammatory Response ◽  
Related Factors

Abstract Background:The percutaneous nephrolithotomy (PCNL) is a primary method of stone treatment, but the infection is a very common postoperative complication. The systemic inflammatory response syndrome (SIRS) is a stage of the infection process and a very important early clinical manifestation of sepsis, so identifying the risk factors associated with SIRS after PCNL plays an important role in ensuring patients’ safety and preventing sepsis. Methods:Between September 2016 and September 2017,there were total 352 patients who were diagnosed as renal stone and were treated with PCNL, andincluded in this study at last.Patients were divided into two groups according to whether SIRS occurred or not.The univariate analysis was performed on the related risk factors such as patients' age, gender, number of stone, diabetes et al. Then logistic regression was used for multivariate analysis and established a prediction model.Results:There are 352renal stone patients were treated with PCNL, and 106 patients (30.1%) suffered SIRS after operation.It was found that the operative time, preoperative fever and diabetes could be deemed as risk factors, and the Then logistic regression results indicated that diabetes (OR=2.049, 95%CI 1.008～4.166) and operative time (OR=1.011, 95%CI 1.003～1.019) entered the regression equation.Conclusion: Diabetes and operative time are independent risk factors for SIRS after PCNL, so the probability of SIRS after PCNL can be determined in accordance with these two indicators.

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