Category: Clinical Stones: PCNL
Introduction & Objective :
Percutaneous Nephrolithotomy (PN L) is a procedure that has traditionally been performed in an inpatient setting with at least an overnight stay. Many surgical procedures have evolved over time from an inpatient setting to an ambulatory surgery center (ASC) setting. Feasibility of Ambulatory PNL (aPNL) was shown in our initial pilot series of 25 cases . This 300 case series is reviewed to further evaluate outcomes with a more robust data set.
We present our initial series of 300 patients who underwent PNL in an ASC from April 2015 to March 2018. Each aPNL was performed by one of two surgeons with the same operative team. All procedures were performed with the operative surgeon obtaining renal access and all procedures were performed tubeless (ureteral stent without a nephrostomy tube). All patients also had hemostatic plugs placed into the access tract with a local intercostal block performed to aid with pain control. All cases were reviewed and demographic data and case details were analyzed.
Our initial 300 consecutive aPNL cases were reviewed, identifying 129 men, 181 right side, one bilateral, mean age 56.5 years (16-86), mean BMI 30 (16- 48 ), mean ASA of 2.2 (range 1 - 3) and mean stone burden 30 mm (5-140mm), mean fluoroscopy time 79 sec (14-299). Mean OR time was 107 min (range 32-305 min). Mean PACU time was 101 min (range 31-240 min). A mini-PCNL procedure was conducted in 42 (14%) patients. Stone free rate was 88%. Twelve patients had complications ranging Clavien I-IVa, of which 3 were hospital transfers.
This consecutive 300 case series further demonstrates the safety of aPNL. While twelve patients experienced complications, the site of service did not lead to an alteration in the outcomes of the adverse events. Each complication that occurred was managed in an appropriate fashion without notable treatment delay. Our complication rate in the ASC is lower than reported in large cohort studies and lower than our hospital based patient population, however recognizing these patients are preselected. With an experienced surgeon, well trained operative team and with modifications to the procedure focusing on post-operative pain control, PNL can be safely and effectively performed in an ASC.
1. Davalos JG, Abbott JE. Ambulatory PCNL: Initial Case Series. J Urology. April 2016. Vol. 195 (4), Supplement 1: MP51-20, e688-e689. 2
2. . Abbott JE, Cicic, A, Jump III RW, Davalos JG. Hemostatic Plug: Novel Technique for Closure of Percutaneous Nephrostomy Tract. J Endourol. March 2015, 29(3): 263-269.
New York, New York
Mark V. Silva, MD
NYU Dept. of Urology
New York, NY