The "mini-perc" technique: a less invasive alternative to percutaneous nephrolithotomy

Abstract

The disadvantages of standard percutaneous nephrolithotomy (PCNL) as compared with ureteroscopy or extracorporeal shock-wave lithotripsy include increased blood loss, greater pain, and longer hospital stay. A 13-Fr "mini-perc" technique using a ureteroscopy sheath for PCNL was developed in an attempt to address these drawbacks. Nine "mini-percs" have been performed in patients aged 40-73 years with stone burdens of < or = 2 cm2. On average, patients had 1.4 stones with a cross-sectional area of 1.5 cm2. The mean total procedure time, estimated blood loss, and hematocrit decrease were 176 min, 83 ml, and 6.6%, respectively. On average, patients used 14 mg of parenteral morphine and stayed 1.7 days in the hospital. There was no procedure-related complication or transfusion. Eight of nine kidneys (89%) were stone-free on early follow-up at a mean of 3.8 weeks. As compared with standard PCNL, the "mini-perc" technique has similar early success rates in selected patients and may offer advantages with respect to hemorrhage, postoperative pain, and shortened hospital stays.

Efficacy of Peri-Operative Intercostal Nerve Blockade in Standard PCNL- A Prospective Cohort Study

“…Since the time first percutaneous stone extraction was done by Fernström & Johannson [6] , there has been drastic improvement in PCNL techniques with recent innovations like miniperc [7,8,9] , microperc and ultra-miniperc. Skin incisions have become smaller, smaller amplantz sheaths and laser lithotripters are being used for stone clearance.…”

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

“…Jackman et al [13] described mPNL in preschool children with acceptable stone free rates. However, some concerns about smaller caliber tracts and instruments such as impaired vision, increased operative time and lower stone-free status have been reported.…”

Ultrasonography-Guided Percutaneous Nephrolithotomy for the Treatment of Kidney Stone

“…The popularity of MPCNL lies in its reported favorable procedural safety, however it has limited indications due to the small percutaneous tract (11-20F versus 26-34F) [13]. As such, MPCNL is primarily used in pediatric patients or adult patients with small stones or as a secondary technique used to supplement conventional PCNL [14]. Advancements in MPCNL equipment and techniques have helped broaden the indication of MPCNL to any UTUL requiring PCNL intervention, as suggested by Guangzhou and colleagues [15].…”