Double-Sheath Vacuum Suction Minimally Invasive Percutaneous Nephrolithotomy for Management of Large Renal Stones

Abstract

<b><i>Objectives:</i></b> This study aimed to describe a novel double-sheath vacuum suction minimally invasive percutaneous nephrolithotomy (mini-PCNL) to overcome the deficiencies of the conventional procedure. <b><i>Patients and Methods:</i></b> Between March 2019 and December 2019, 65 patients (37 males and 28 females) with a mean age of 41 years (range 23–69) underwent mini-PCNL with double-sheath vacuum suction. It consisted of an F20 Y-shaped sheath as an outer sheath and an F16 Y-shaped sheath as an inner sheath, in which the inner sheath was longer than the outer sheath. The oblique arm of the outer sheath and the inner sheath was connected to the perfusion inflow and the vacuum suction, respectively. A 550-μm holmium-YAG laser was introduced for stone fragmentation through the working channel of the mini-nephroscope, which was no longer connected to the perfusion fluid. <b><i>Results:</i></b> All procedures were successful. Mean operation time was 50.2 min (range 39–83). Mean hemoglobin decrease was 5.2 g/L (range 1.0–15.5), and no patient needed a blood transfusion. One patient (1.5%) with low fever (<38°C) at day 1 had returned to normal at day 2 without administration of antibiotics. There were no Clavien grade 2–4 complications. Mean postoperative hospital stay was 2.4 days (range 2–6). The initial stone-free rate of PCNL was 81.53% (53 of 65 patients). One month after surgery, the final stone-free rate increased to 90.77% (59/65 patients). <b><i>Conclusions:</i></b> The double-sheath vacuum suction mini-PCNL is a safe and effective modality for large renal stones, which might increase the efficiency of stone extraction with low intrapelvic pressure.

Assessment of Effectiveness and Safety of Aspiration-Assisted Nephrostomic Access Sheaths in PCNL and Intrarenal Pressures Evaluation: A Systematic Review of the Literature

“…Among the 25 studies included in this review, 13 were retrospective [11][12][13][14][15][16][17][18][19][20][21][22][23] and 12 were prospective [24][25][26][27][28][29][30][31][32][33][34][35]; 6 of the latter were randomised trials [25,26,29,31,32,35].…”

“…A total of 11 papers analysed the use of the Clear Petra ® (Well Lead Medical Co., Ltd., Guangzhou, China) nephrostomic access sheath [12][13][14][15][16][17][18]22,26,29,31]; 3 articles focused on the Superperc technique performed by means of the Shah sheath [25,28,30]; 1 article described a single series of procedures performed with both the above-mentioned devices [33]; 5 articles explored the use of SuperminiPCNL (SMP) [19,20,23,24,34]; 5 articles reported outcomes of a Chinese-patented miniPCNL suctioning sheath [11,21,27,32,35]. Table 1 reports the above mentioned studies and their main characteristics.…”

“…Of the 25 articles included, 11 focus on the Clear Petra system [12][13][14][15][16][17][18]22,26,29,31]. The Clear Petra set is composed of a nephrostomic access sheath with its stylet, a connection tube, and a stone collection bottle.…”

“…In the studies analysed, the employed sheath size was from 14 to 20 Fr. To overcome the possible drawbacks deriving from the occurrence of inflow and outflow through the same cavity and to further improve the effectiveness of the procedure, in three articles [15][16][17], the Clear Petra access sheath is not employed in the conventional way as previously described. The authors create a double-sheath vacuum-suction system, wherein a 16 Fr large, 21 cm long inner Clear Petra sheath is inserted into a 20 Fr large, 13 cm long outer one.…”

A novel double-sheath negative-pressure versus conventional minimally invasive percutaneous nephrolithotomy for large kidney stone

“…While these efforts have led to improvements, they have not fully resolved all the challenges associated with this technique. To address these deficiencies, we developed a novel double-sheath negative-pressure mPCNL (D-mPCNL), consisting of a 20F Y-shaped sheath as the outer sheath and a 16F Y-shaped sheath as the inner sheath 9 .…”