Objective: This study aims to evaluate the learning curve of the urologist to perform supine PCNL and the perioperative outcome of patients based on a single surgeon’s experience. Material & Methods: 60 consecutive patients who underwent modified supine PCNL for renal stone were analyzed. A single experienced urological surgeon performed the supine PCNL. Mean operative time, drop in hemoglobin level, stone-free rate, complications, and length of hospital stay were analyzed to evaluate the learning curve of the surgeon. All parameters were compared among all six groups obtained from the 60 cases in chronological order. Besides, the outcomes of supine PCNL were also compared to prone PCNL. Results: Mean operative time from 60 cases of supine PCNL was 100 ± 27 minutes. The mean operative time was decreased over time, particularly after 20 cases. Significantly different mean operative times (89 ± 14 minutes vs. 126 ± 21 minutes, p < 0.001) in the groups of cases 21-60 compared to the group of 1–20 cases were observed. The total stone-free rate for supine PCNL from all cases was 68%. There was no difference regarding the reduction of hemoglobin level, stone-free rate, hospital stay, and complication rate. No major complication was found among study subjects. Supine PCNL showed similar outcome parameters compared to prone PCNL. Conclusion: The surgeon acquired the surgical competencies to perform supine PCNL after 20 cases. The supine PCNL could remove the kidney stone as effective and safe as prone PCNL.
Learning curve, PCNL, operative time, supine position, kidney stones
Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol. 1998; 160: 1975-8.
Basiri A, Mohammadi Sichani M. Supine percutaneous nephrolithotomy, is it really effective? A systematic review of literature. Urol J. 2009; 6: 73-7.
Valdivia JG, Scarpa RM, Duvdevani M, et al. Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol. 2011; 25: 1619-25.
Ghani KR, Andonian S, Bultitude M, et al. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol. 2016; 70: 382-96.
Tanriverdi O, Boylu U, Kendirci M, Kadihasanoglu M, Horasanli K, Miroglu C. The learning curve in the training of percutaneous nephrolithotomy. Eur Urol. 2007; 52: 206-11.
Ibarluzea G, Scoffone CM, Cracco CM, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int. 2007; 100: 233-6.
Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. European urology. 2016; 69: 475-82.
Sofer M, Tavdi E, Levi O, et al. Implementation of supine percutaneous nephrolithotomy: a novel position for an old operation. Cent European J Urol. 2017; 70: 60-5.
Nour HH, Kamal AM, Ghobashi SE, et al. Percutaneous nephrolithotomy in the supine position: Safety and outcomes in a single-centre experience. Arab J Urol. 2013; 11: 62-7.
Duty B, Okhunov Z, Smith A, Okeke Z. The debate over percutaneous nephrolithotomy positioning: a comprehensive review. J Urol. 2011; 186: 20-5.
De Sio M, Autorino R, Quarto G, et al. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol. 2008; 54: 196-202.
Allen D, O'Brien T, Tiptaft R, Glass J. Defining the learning curve for percutaneous nephrolithotomy. J Endourol. 2005; 19: 279-82.
Jang WS, Choi KH, Yang SC, Han WK. The Learning Curve for Flank Percutaneous Nephrolithotomy for Kidney Calculi: A Single Surgeon's Experience. Korean J Urol. 2011; 52: 284-8.
Sofer M, Beri A, Friedman A, et al. Extending the application of tubeless percutaneous nephrolithotomy. Urology. 2007; 70: 412-6.
Al-Dessoukey AA, Moussa AS, Abdelbary AM, et al. Percutaneous nephrolithotomy in the oblique supine lithotomy position and prone position: a comparative study. J Endourol. 2014; 28: 1058-63.
Wang Y, Wang Y, Yao Y, et al. Prone versus modified supine position in percutaneous nephrolithotomy: a prospective randomized study. Int J Med Sci. 2013; 10: 1518-23.