Mini percutaneous nephrolithotripsy with ultrasound-guided approach in the lateral decubitus position under spinal anesthesia at Viet Duc University Hospital

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Huy Hoàng Nguyễn ◽  
Trường Thành Đỗ ◽  
Ngọc Sơn Đỗ
Keyword(s):  
Minimally Invasive ◽  
Spinal Anesthesia ◽  
Kidney Stones ◽  
Ultrasound Guidance ◽  
Lateral Decubitus Position ◽  
Ultrasound Guided ◽  
Stone Free Rate ◽  
Lateral Decubitus ◽  
Percutaneous Nephrolithotripsy ◽  
Free Rate

Tóm tắt Đặt vấn đề: Can thiệp xâm lấn tối thiểu hiện nay đã thay thế phần lớn phẫu thuật mở trong điều trị bệnh sỏi thận. Nghiên cứu nhằm đánh giá hiệu quả của | phẫu thuật tán sỏi thận qua da đường hầm nhỏ dưới hướng dẫn của siêu âm với người bệnh (NB) ở tư thế nằm nghiêng và gây tê tuỷ sống tại khoa Tiết niệu bệnh viện Việt Đức. Phương pháp nghiên cứu: Mô tả tiến cứu 250 trường hợp sỏi thận được tán sỏi qua da đường hầm nhỏ tại khoa Tiết niệu bệnh viện Việt Đức từ tháng 3/2017 | đến tháng 8/2017. NB được gây tê tuỷ sống, đặt tư thế nằm nghiêng. Chọc dò, tạo đường hầm qua da dưới hướng dẫn siêu âm với nong Amplatz 18 Fr. Sử dụng ống soi niệu quản bán cứng tán sỏi thận bằng Holmium laser 80W. Đánh giá tỷ lệ sạch sỏi và biến chứng sau mổ. Kết quả: 250 NB gồm 176 nam (70,4%) và 74 nữ (29,6%). Tuổi trung bình là 47,13 + 24,31 tuổi (22 - 85). Sỏi bể thận chiếm 34,4%, sỏi đài thận dưới gặp 7,6%, sỏi bể thận và 1 đài 35,6%, sỏi san hô chiếm 22,4%. Sỏi bên phải 38,8% và sỏi bên trái 61,2%, 69 NB (27,6%) có sỏi thận bên đối diện. Phát hiện ứ nước thận trên chụp cắt lớp vi tính (MSCT) trước mổ: 37 đài bể thận bình thường (14,8%); độ 1 gặp 120 (48%), độ 2 gặp 58 (23,2%), độ 3 gặp 35 (14%). Kích thước sỏi: Chiều dài trung bình (TB): 2,41 + 0,86cm (1 - 4,8cm), chiều rộng TB: 1,62 + 0,56cm (1 - 3,2cm). Vị trí đường hầm vào đài giữa 82,4%, đài dưới 16,8%, đài trên 0,8%. Thời gian mổ trung bình: 69,53 + 27,18 phút (35 - 120). Tất cả sỏi thận đều được tán qua da thành công. Biến chứng trong mổ gặp | 9 NB chảy máu (3,6%) không cần truyền máu. Biến chứng sau mổ gặp 5,2% gồm: 1 chảy máu sau mổ được nút mạch chọn lọc, 8 NB sốt sau mổ, 3 NB sốc nhiễm trùng được điều trị tích cực ổn định, 1 NB tử vong do sốc nhiễm trùng và chảy máu. Thời gian nằm viện TB: 4,57 + 2,64 ngày (2 - 8). Dẫn lưu thận | rút sau 2 - 5 ngày (TB: 2,87 + 1,43 ngày). Tỷ lệ sạch sỏi sớm sau mổ: 80,7%. Theo dõi sau mổ: 249 NB khám lại sau 1 tháng và rút ống thông JJ với tỷ lệ sạch sỏi đạt 97,2%. Kết luận: Tán sỏi thận qua da đường hầm nhỏ dưới hướng dẫn siêu âm NB ở tư thế nằm nghiêng và gây tê tuỷ sống mang lại nhiều lợi ích, nên là phương pháp được chọn lựa để điều trị bệnh lý sỏi thận. Abstract Introduction: Minimally invasive treatments have almost completely replaced open surgery in the management of the kidney stone disease. Our study aimed to evaluated the effectiveness of mini percutaneous nephrolithotripsy (mini-PCNL) with ultrasound-guided access in the lateral decubitus position under spinal anesthesia. Material and Methods: Prospective study of 250 kidney stones cases treated by mini-PCNL management at Urology Department of Viet Duc hospital from March 2017 to August 2017. Patients underwent & lyed spinal anesthesia, lying on the side. Small percutaneous renal access tract was performed under the ultrasound guidance with Amplatz dilation sheath 18Fr. Holmium laser nephrolithotripsy was used with semi-rigidureteroscope. Objective: Evaluate the postoperative stone free rate and complication rate. Results: 176 males (70,4%) and 74 females (29,6%) with the average age of 47,13 + 24,31 (range from 22 to 85 years old). Stone site: Renal pelvis: 34,4%; lower calyx 7,6%; pelvis and 1 calyx: 35,6% and staghorn calculi: 22,4%. Right kidney stones:38,8%; Left kidney stones: 61,2% and associate opposite kidney stones: 69 (27,6%). The finding of Hydronephrosis on preoperative MSCT includes: normal: 37 cases (14,8%); grade 1: 120cases (48%); grade 2: 58 (23,2%) and grade 3: 35 (14%). Stone size: mean length: 2,41 +0,86cm (1 - 4,8); mean width: 1,62 = 0,56cm (1 - 3,2). Renal access tract:middle calyx 82,4%; lower calyx 16,8%; upper calyx 0,8%. Average operative time: 69,53 + 27,18 minutes (35 - 120). Laser lithotripsy and stone removal are successful in 100% cases. Peroperative complications: 9 cases of haemorrhage (3,6%) with out blood transfusion requirement. The rate of postoperative early complication was 5,2%: 1 case of haemorrhage requiring embolization, 8 cases have fever. 3 patients with septicemia shock was medically treated and stabilized. 1 patient died from infection and bleeding. The mean of hospital stay: 4,57 = 2,64 day (2 -8). Nephrostomy tube removal after: 2,87 = 1,43 days (2 - 5). Stone free rate: 80,7%. At the postoperative follow-up 1 months, renal function is recovered well and JJ is removed. Stone free rate after 1 month: 97,2%. Conclusion: Mini-PCNL using ultrasound guidance in the lateral decubitus position under spinal anesthesia offers many advantages and should be the chosen method in the treatment of kidney stones. Keyword: Kidney stones, Mini-PCNL, Minimally invasive treatment, spinal anesthesia.

Tubeless percutaneous nephrolitotripsy without drainage in the lateral decubitus position using spinal anesthesia method and ultrasound guidance

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Long Hoàng ◽  
Quốc Hòa Trần ◽  
Keyword(s):  
Minimally Invasive ◽  
Spinal Anesthesia ◽  
Kidney Stones ◽  
Ultrasound Guidance ◽  
Minimally Invasive Treatment ◽  
Invasive Treatment ◽  
Stone Free Rate ◽  
Lateral Decubitus ◽  
Percutaneous Nephrolithotripsy ◽  
Free Rate

Tóm tắt Đặt vấn đề: Các phương pháp can thiệp ít xâm lấn hiện nay đã thay thế phần lớn phẫu thuật mở trong điều trị bệnh sỏi thận. Nghiên cứu đánh giá khả năng ứng dụng và hiệu quả của phẫu thuật tán sỏi thận qua da đường hầm nhỏ dưới gây tê tủy sống và hướng dẫn siêu âm ở tư thế nằm nghiêng không dẫn lưu thận. Phương pháp nghiên cứu: Mô tả tiến cứu 120 trường hợp sỏi thận được tán sỏi thận qua da đường hầm nhỏ dưới hướng dẫn siêu âm và không dẫn lưu thận tại Bệnh viện Hữu nghị Việt Đức và Bệnh viện Đại học Y Hà Nội từ 7/2016 đến 7/2018. Chọc dò và tạo đường hầm qua da vào thận dưới hướng dẫn siêu âm với nong Amplatz 18 Fr. Sử dụng với ống soi niệu quản bán cứng tán sỏi thận bằng Holmium laser 80W. Đánh giá tỷ lệ sạch sỏi và biến chứng sau mổ. Kết quả: 120 NB gồm 75 nam (62,5%) và 45 nữ (37,5%). Tuổi trung bình là 51,14 ± 24,57 tuổi (11 - 88 tuổi). Sỏi tái phát: 7 NB (5,8%). Sỏi bể thận chiếm tỷ lệ 25,8%; sỏi đài thận dưới gặp 5%; sỏi bể thận và 1 đài 35%; sỏi san hô chiếm tỷ lệ 34,2%. Sỏi bên phải 37,5% và sỏi bên trái 60%; 3 NB (2,5%) có sỏi thận hai bên. Phát hiện ứ nước thận trên MSCT trước mổ: 46 đài bể thận bình thường (38,3%); độ I gặp 51 (42,5%); độ II gặp 20 (16,7%); độ III gặp 3 (2,5%). Kích thước sỏi: Chiều dài TB: 2,34 ± 0,87cm (1,4 - 4,5cm), chiều rộng TB: 1,43 ± 0,62cm (0,8 - 3,5cm). Vị trí đường hầm vào đài giữa 89,2%, đài dưới 8,3%, đài trên 2,5%. Thời gian mổ trung bình: 47,57 ± 23,75 phút (15 - 90 phút). Tất cả sỏi thận đều được tán qua da thành công. Diễn biến trong mổ gặp 5 NB chảy máu chiếm 4,2%; không cần truyền máu. Sau mổ không gặp biến chứng chảy máu, tụ dịch quanh thận hay rò nước tiểu; chỉ có 7 NB sốt nhẹ sau mổ được điều trị ổn định chiếm 5,8% độ 1 theo phân loại Clavien Dindo. Thời gian nằm viện trung bình 2,82 ± 1,34 ngày (2 - 5 ngày). Tỷ lệ sạch sỏi sớm sau mổ: 85,8%. Theo dõi sau mổ: 120 NB khám lại sau 1 - 4 tháng và rút ống thông JJ với tỷ lệ sạch sỏi đạt 91,7%. Không gặp các biến chứng khác như nhiễm khuẩn tiết niệu, chảy máu hay sỏi tắc nghẽn niệu quản. Kết luận: Tán sỏi thận qua da đường hầm nhỏ ở tư thế nằm nghiêng không dẫn lưu thận dưới gây tê tủy sống và hướng dẫn siêu âm đạt hiệu quả tối ưu nên được chọn lựa đầu tiên để làm giảm biến chứng và tăng tỷ lệ sạch sỏi trong điều trị sỏi đài bể thận. Abstract Introduction: Minimally invasive treatment has almost replaced open surgery in the management of the kidney stones. The aim of study is to evaluate the feasibility and effectiveness in implementing the tubeless or mini-percutaneous nephrolithotripsy (PCNL) without drainage in the lateral decubitus position using spinal anesthesia and ultrasound-guided. Material and Methods: Prospective study of 120 kidney stones cases treated by tubeless PCNL at the Urology Department of Viet Duc hospital and Hanoi Medical University hospital from July 2016 to July 2018. Small percutaneous renal access tract is performed under the ultrasound guidance with Amplatz dilation sheath 18Fr. Holmium laser nephrolithotripsy is used with semi-rigidureteroscope. The postoperative stone free rate as well as complication rate were evaluated. Results: 75 males (62.5%) and 45 females (37.5%) with the average age of 51.14 ± 24.57 years old (range from 11 to 88). Recurrent stones: 7 cases (5.8%). Stone site: Renal pelvis: 31 (25.8%); lower calyx 6 (5%); pelvis and 1 calyx: 42 (35%) and staghorn calculi: 41 (34.2%). Right kidney stones:45 (37.5%); Left kidney stones: 72 (60%) and associate opposite kidney stones: 3 (2.5%). Hydronephrosis detected on multiple slide CT scanner prior to surgery including: Normal: 46 cases (38.3%); grade 1: 51 cases (42.5%); grade 2: 20 (16.7%) and grade 3: 5 (2.5%). Stone size: mean length: 2.34 ± 0,87cm (1.4 – 4.5); mean width: 1.43 ± 0.62cm (0.8 – 3.5). Renal access tract:middle calyx 107 (89.2%); lower calyx 10 (8.3%); upper calyx 3 (2.5%). Average operative time: 47.57 ± 23.75 minutes (15 - 90). Laser lithotripsy and stone removalare successful in 100% cases. Preoperative complications: bleeding in 5 cases (4.2%) but not required blood transfusion. No major early postoperative complication. 7 cases of postoperative fever were treated and stabilized (5.8% grade 1 of Clavien Dindo classification). The mean of length stay was 2.82 ± 1.34 days (2 - 5). Early stone free rate: 85.8%. At the postoperative follow-up from 1 - 4 months, renal function recovered well and JJ was removed. No severe complications such as urosepsis, bleeding, seroma around kidney or steinstrass. Stone free rate after 1 month was 91.7%. Conclusion: Tubeless or mini- PCNL was performed under the spinal anesthesia and ultrasound guidance is a safe and effective method as the first choice for management of kidney stones that could help to reduce complications and improve the stone free rate. Keyword: Mini-percutaneous nephrolithotripsy, Minimally invasive treatment, Tubeless.

Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal puncture: Initial single-surgeon experience at a UK teaching hospital

2017 ◽  
Vol 10 (6) ◽  
pp. 535-540
Author(s):  
N Nkwam ◽  
MA Khan
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Ultrasound Guidance ◽  
Plain Film ◽  
Ultrasound Guided ◽  
Visceral Injury ◽  
Stone Free Rate ◽  
Surgeon Experience ◽  
Clavien Grade ◽  
Low Incidence ◽  
Free Rate

Objective: The purpose of this article is to report the outcomes of our initial experience of performing percutaneous nephrolithotomy in the supine position using ultrasound guidance in addition to fluoroscopy for renal access. Patients and methods: The first 34 consecutive modified supine percutaneous nephrolithotomy cases performed by a single consultant urologist inserting their own percutaneous tracts using ultrasound-guidance and fluoroscopy were evaluated. Operative data was collected prospectively over a 10-month period including any complications. The stone-free rate was evaluated three months post-operatively with a plain film or non-contrast computed tomography of the kidneys, ureters and bladder. Results: Renal access was achieved in all 34 cases. Mean age was 57 years (19–82) with 14 males and 20 females. Mean stone size 37.2 mm (20–72 mm). Overall stone-free rate was 85.3% at a mean follow up of 11.2 months. There was one Clavien Grade I, and three Clavien Grade II complications of post-operative fever requiring treatment with intravenous antibiotics. No patients developed urosepsis, required blood transfusion or sustained any visceral injury. Median in-patient stay was one night (1–4). Conclusion: Modified supine percutaneous nephrolithotomy with combined fluoroscopy and ultrasound-guided renal access has a low incidence of complications allowing for short hospital stay.

Minimally invasive oesophagectomy in the prone versus lateral decubitus position: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Dimitrios Schizas ◽  
Dimitrios Papaconstantinou ◽  
Anastasia Krompa ◽  
Antonios Athanasiou ◽  
Tania Triantafyllou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Meta Analysis ◽  
Lateral Decubitus Position ◽  
Prone Positioning ◽  
Respiratory Complications ◽  
Invasive Esophagectomy ◽  
Postoperative Respiratory Complications ◽  
Lateral Decubitus

Abstract The thoracic phase of minimally invasive esophagectomy was initially performed in the lateral decubitus position (LDP); however, many experts have gradually transitioned to a prone position (PP) approach. The aim of the present systematic review and meta-analysis is to quantitatively compare the two approaches. A systematic literature search of the MEDLINE, Embase, Google Scholar, Web of Knowledge, China National Knowledge Infrastructure and ClinicalTrials.gov databases was undertaken for studies comparing outcomes between patients undergoing minimally invasive esophageal surgery in the PP versus the LDP. In total, 15 studies with 1454 patients (PP; n = 710 vs. LDP; n = 744) were included. Minimally invasive esophagectomy in the PP provides statistically significant reduction in postoperative respiratory complications (Risk ratios 0.5, 95% confidence intervals [CI] 0.34–0.76, P < 0.001), blood loss (weighted mean differences [WMD] –108.97, 95% CI –166.35 to −51.59 mL, P < 0.001), ICU stay (WMD –0.96, 95% CI –1.7 to −0.21 days, P = 0.01) and total hospital stay (WMD –2.96, 95% CI –5.14 to −0.78 days, P = 0.008). In addition, prone positioning increases the overall yield of chest lymph node dissection (WMD 2.94, 95% CI 1.54–4.34 lymph nodes, P < 0.001). No statistically significant difference in regards to anastomotic leak rate, mortality and 5-year overall survival was encountered. Subgroup analysis revealed that the protective effect of prone positioning against pulmonary complications was more pronounced for patients undergoing single-lumen tracheal intubation. A head to head comparison of minimally invasive esophagectomy in the prone versus the LDP reveals superiority of the former method, with emphasis on the reduction of postoperative respiratory complications and reduced length of hospitalization. Long-term oncologic outcomes appear equivalent, although validation through prospective studies and randomized controlled trials is still necessary.

scholarly journals COMPARISON OF THE EFFICACY AND SAFETY OF THE SUPINE AND PRONE POSITIONS IN PERCUTANEOUS NEPHROLITHOTOMIES FOR KIDNEY STONES

2019 ◽  
pp. 60-62
Author(s):  
RIO RAHMADI ◽  
NUR RASYID ◽  
PONCO BIROWO
Keyword(s):  
Kidney Stones ◽  
Controlled Trial ◽  
Similar Efficacy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Efficacy And Safety ◽  
Conversion To Open Surgery ◽  
Stone Free Rate ◽  
Student’S T ◽  
Free Rate

Objective: This study was designed to compare the efficacy and safety of the supine and prone positions in percutaneous nephrolithotomies (PCNLs) used for the treatment of kidney stones in Indonesian patients. Methods: This was a single-blinded randomized controlled trial of those patients undergoing PCNLs from February to May of 2018. There were 19 subjects in the supine group and 19 in the prone group for a total of 38 study subjects. The study outcomes that were compared included the operative time, hospital length of stay (LOS), stone-free rate, blood loss, conversion to open surgery, blood transfusion, and complications. These outcomes were evaluated using the Student’s t test and the chi-squared test. Results: There were no significant differences in the patient demographics or stone locations between the two groups. Additionally, the medians of the operative times, LOSs, blood losses, and blood transfusions were not statistically different. There was a higher stone-free rate in the supine group than in the prone group (70.0% vs. 47.4%, respectively, p = 0.151). More subjects were transfused in the supine group (30.0%) than in the prone group (15.8%), but this difference was not statistically significant (p = 0.292). The only complications were infundibular lacerations, which occurred in 20% of the subjects in the supine group and 15.8% of the subjects in the prone group (p = 0.732). Conclusion: This study showed that the supine and prone positions for PCNLs had similar efficacy and safety outcomes.

scholarly journals Flexible ureterorenoscopy in position or fusion anomaly: Is it feasible?

2017 ◽  
Vol 63 (8) ◽  
pp. 685-688 ◽  
Author(s):  
Rafael Haddad Astolfi ◽  
Gustavo Freschi ◽  
Fernando Figueiredo Berti ◽  
Nelson Gattas ◽  
Wilson Rica Molina Junior ◽  
...  
Keyword(s):  
Kidney Stones ◽  
Perioperative Complications ◽  
Horseshoe Kidney ◽  
Renal Calculi ◽  
Flexible Ureterorenoscopy ◽  
Renal Anomalies ◽  
Stone Free Rate ◽  
Perioperative Complication ◽  
The Mean ◽  
Free Rate

Summary Objective: To analyze the results of flexible ureterorenoscopy (F-URS) with holmium laser in the treatment of kidney stones with ectopic and fusion anomalies (horseshoe kidney and rotation anomalies). Method: We reviewed data from 13 patients with fusion and ectopic renal anomalies that underwent F-URS from April 2011 to April 2017. We analyzed demographic and clinical data (age, gender, BMI, anatomical abnormality, location and dimension of the renal calculi) and perioperative data (method of treatment, stone-free rate, number of days with DJ catheter and perioperative complications). Results: The mean stone size was 12.23 +/- 5.43 mm (range 6-22mm), located in the inferior (58.33%) and middle (16.76%) calyceal units, renal pelvis (16.67%) and multiple locations (8.33%). All 13 patients were treated with Ho-Yag laser, using dusting technique (25%), fragmentation and extraction of the calculi (58.33%) and mixed technique (16.67%). We did not have any severe perioperative complication. After 90 days, nine patients (75%) were considered stone free. Conclusion: Our data suggest that F-URS is a safe and feasible choice for the treatment of kidney stones in patients with renal ectopic and fusion anomalies.

The Influence of Spinal Flexion in the Lateral Decubitus Position on the Unilaterality of Spinal Anesthesia

2013 ◽  
Vol 117 (4) ◽  
pp. 1017-1021 ◽  
Author(s):  
Jin-Tae Kim ◽  
Jong-Hwan Lee ◽  
Chan-Woo Cho ◽  
Hyo-Cheol Kim ◽  
Jae-Hyon Bahk
Keyword(s):  
Spinal Anesthesia ◽  
Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
Spinal Flexion

scholarly journals The Advantages of the Lateral Decubitus Position After Spinal Anesthesia with Hyperbaric Tetracaine

1998 ◽  
Vol 87 (4) ◽  
pp. 879-884
Author(s):  
Mariko Sumi ◽  
Shinichi Sakura ◽  
Masayuki Koshizaki ◽  
Yoji Saito ◽  
Yoshihiro Kosaka
Keyword(s):  
Spinal Anesthesia ◽  
Lateral Decubitus Position ◽  
Lateral Decubitus ◽  
Hyperbaric Tetracaine
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