Complete supine percutaneous nephrolithotomy with lung inflation avoids the need for a supracostal puncture.

Purpose: The aim of this study was to evaluate the safety and efficacy of subcostal upper pole (UP) access in complete supine percutaneous nephrolithotomy (csPCNL).

Materials And Methods: From July 2008 to February 2009, we performed 20 PCNLs in complete supine position. We present our experience of percutaneous approach in complete supine position to the renal superior calix, while insisting on renal displacement technique to facilitate the puncture of the superior calices and to decrease intrathoracic morbidity. The renal displacement technique was carried out with lung inflation.

Results: The percutaneous subcostal access of the renal UP was performed in 20 cases and no failure occurred. The overall stone-free rate was 85%, and the stone-free rate for upper calix was 95%. The mean operative time in our study was 102.25 +/- 41.56 minutes. The mean hospital stay was 92.4 +/- 30.43 hours. The transfusion rate as a complication was 1 (5%), and no intrathoracic complication was noted.

Conclusions: The renal UP percutaneous access can be performed using several techniques. The superior calix was accessible in csPCNL with the renal displacement technique (lung inflation) subcostally while intrathoracic complications may be avoided. UP puncture in csPCNL with this technique was associated with minimal morbidity and avoids the need for a supracostal puncture, and the stone-free rate appeared to be more.