Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Ultrasonography-Assisted Combined Puncture Technique in Supine Mini Percutaneous Nephrolithotomy: Descriptive Research
Supin Mini Perkütan Nefrolitotomide Ultrasonografi Yardımlı Kombine Giriş Tekniği: Tanımlayıcı Araştırma
Ahmet Yıldırım BALIKa , Muammer BABAYİĞİTb , Serdar GEYİKb
aDüzce University Faculty of Medicine, Department of Urology, Düzce, Türkiye
bAksaray Training and Research Hospital, Clinic of Urology, Aksaray, Türkiye
J Reconstr Urol. 2024;14(3):95-101
doi: 10.5336/urology.2024-107810
Article Language: EN
Full Text
ABSTRACT
 Objective: As surgeons in the early years of post-residency training, we aimed to share the clinical outcomes, safety, and efficacy of the entry method we implemented using ultrasound and fluoroscopy together in supine mini percutaneous nephrolithotomy (PNL) surgeries. Material and Methods: Between November 2022 and April 2024, 20 patients who underwent supine mini PNL with a combined entry method using ultrasonography and fluoroscopy were retrospectively evaluated. The imaging, laboratory, and surgical data of patients operated on by urologists in their early years following specialty training were collected. The demographic characteristics, age, gender, side of surgery, operative time, blood transfusion, length of hospital stay, complications, preoperative stone volumes, decrease in hemoglobin levels on postoperative day 1, stone removal rates, fluoroscopy times, total fluoroscopy doses, and complications were analyzed. Results: A total of 20 patients, including 12 men and 8 women, underwent supine mini PNL. The mean operative time was 64±14.33 minutes. Entry was successfully achieved in all patients using ultrasound and fluoroscopy guidance. No significant bleeding or organ injury related to the entry was observed. The stone-free rate determined by comparing preoperative and postoperative imaging was 87.6%±13.68%. The mean fluoroscopy duration was 65.8±22.4 seconds. According to the Clavien complication classification, Grade 1 complications were observed in 4 patients, Grade 2 in 4 patients, and Grade 3A in 1 patient. Conclusion: In conclusion, based on our experience, we believe that the combined use of ultrasound and fluoroscopy in supine mini PNL surgeries provides a safe, straightforward approach with low radiation exposure.

Keywords: Percutaneous nephrolithotomy; supine mini percutaneous nephrolithotomy; supine position; ultrasonography
ÖZET
 Amaç: Uzmanlık eğitimi sonrası ilk yıllarındaki cerrahlar olarak supin mini perkütan nefrolitotomi (PNL) cerrahisinde ultrason ve floroskopiyi birlikte kullanarak uyguladığımız giriş yönteminin klinik sonuçlarını, güvenirliğini ve etkinliğini paylaşmayı amaçladık. Gereç ve Yöntemler: Kasım 2022-Nisan 2024 tarihleri arasında ultrasonografi ve floroskopi birlikteliğinde kombine giriş yöntemi uygulanarak supin mini PNL uygulanan 20 hasta retrospektif olarak değerlendirildi. Uzmanlık eğitimi sonrası yeni uzman ürologlar tarafından yapılan cerrahilerdeki hastaların görüntüleme, laboratuvar ve cerrahi özellik kayıtları toplandı. Hastaların demografik özellikleri, yaş, cinsiyet, taraf, operasyon süresi, kan transfüzyonu, hastanede yatış süresi, komplikasyonları, preop taş büyüklükleri, postop 1. günde hemoglobindeki düşüş, taşların alınma oranları, floroskopi süreleri, toplam floroskopi dozları ve komplikasyonlar incelendi. Bulgular: 12 erkek 8 kadın olmak üzere toplam 20 hastaya supin mini PNL yapıldı. Ortalama operasyon süresi 64±14,33 dk idi. Tüm hastalara ultrasonografi ve floroskopi eşliğinde giriş yapıldı. Girişe bağlı ciddi bir kanama veya organ hasarı saptanmadı. Taşların preop ve postop görüntülemelerle karşılaştırılmasıyla saptanan taşların dışarı alınma oranları ise %87,6±13,68 olarak saptandı. Ortalama floroskopi kullanım süresi 65,8±22,4 sn saptandı. Clavien komplikasyon sınıflamasına göre 4 hastada Derece 1, 4 hastada Derece 2 ve 1 hastada Derece 3A komplikasyon saptandı. Sonuç: Sonuç olarak başlangıç deneyimlerimize göre supin mini PNL cerrahilerinde ultrasonografi ile floroskopinin kombine kullanımı ile yapılan girişin; güvenli, kolay ve düşük radyasyon maruziyetli olduğunu düşünmekteyiz.

Anahtar Kelimeler: Perkütan nefrolitotomi; supin mini perkütan nefrolitotomi; supin pozisyon; ultrasonografi
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