Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr;52(4):284-8.
doi: 10.4111/kju.2011.52.4.284. Epub 2011 Apr 22.

The Learning Curve for Flank Percutaneous Nephrolithotomy for Kidney Calculi: A Single Surgeon's Experience

Won Sik Jang  1 , Kyung Hwa Choi, Seung Choul Yang, Woong Kyu Han
Affiliations

The Learning Curve for Flank Percutaneous Nephrolithotomy for Kidney Calculi: A Single Surgeon's Experience

Won Sik Jang et al. Korean J Urol. 2011 Apr.

Abstract

Purpose: Percutaneous nephrolithotomy (PCNL) is conventionally conducted in the prone position. However, the prone position increases anesthesia-related morbidity and position changes lengthen the operation time. We report perioperative outcomes and the learning curve for flank PCNL on the basis of a single surgeon's experience.

Materials and methods: This study investigated 53 cases of flank PCNL performed for renal stones at our institution from April 2008 to September 2010. We compared mean operative time, stone-free rate, drop in hemoglobin level, length of hospital stay, complications, and need for additional procedures after the surgery. The 53 cases were divided into three groups by case number to compare therapeutic effect, stability, and the learning curve for flank position PCNL.

Results: The mean operation time for the 53 patients was 97.3±43.1 minutes. The mean operation time gradually decreased as the surgeon accumulated experience. From the 36th case, the mean operation time showed a statistically significant decrease to 72.2±24.1 minutes (p=0.003). The overall stone-free rate was 64.2% for all procedures (range, 61.1-76.5%). There were no significant differences in the drop in hemoglobin level, stone-free rate, re-treatment, hospital stay, or complication rate. There was no injury to the bowel or renal vessels, and no other major complications occurred.

Conclusions: Flank PCNL can be used to remove renal stones effectively while overcoming the disadvantages of the existing prone position PCNL. After 36 cases, the learning curve showed acquisition of surgical competence. The clinical experience reported here suggests that flank PCNL is a safe and feasible technique.

Keywords: Kidney calculi; Learning curve; Percutaneous nephrolithotomy.

PubMed Disclaimer

Conflict of interest statement

The authors have nothing to disclose.

Figures

FIG. 1
FIG. 1
(A) True supine position. (B) Flank position; position at the beginning of operation and after access. (C) Lateral position; position for renal access.
FIG. 2
FIG. 2
Fluoroscopic picture of renal puncture.
FIG. 3
FIG. 3
The surgeon's operating time.
See this image and copyright information in PMC

References

    1. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10:257–259. - PubMed
    1. Valdivia Uría JG, Valle Gerhold J, López López JA, Villarroya Rodriguez S, Ambroj Navarro C, Ramirez Fabián M, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol. 1998;160:1975–1978. - PubMed
    1. Kerbl K, Clayman RV, Chandhoke PS, Urban DA, De Leo BC, Carbone JM. Percutaneous stone removal with the patient in a flank position. J Urol. 1994;151:686–688. - PubMed
    1. Stambough JL, Dolan D, Werner R, Godfrey E. Ophthalmologic complications associated with prone positioning in spine surgery. J Am Acad Orthop Surg. 2007;15:156–165. - PubMed
    1. Segura JW, Patterson DE, LeRoy AJ, May GR, Smith LH. Percutaneous lithotripsy. J Urol. 1983;130:1051–1054. - PubMed