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Published: November 5, 2018

Supine PCNL

ADVANTAGES

  • FASTER
  • FASTER TURNAROUND TIME
  • NO NEED TO POSITION PATIENT FOR CONCURRENT ENDOUROLOGICAL WORK

ANAESTHESIA

  • NO NEED PARALYSIS
  • PATINT DOESNT NEED AN ARMOURMED TUBE AND CAN JUST USE A LARYNGEAL MASK
  • NO NEED EYE PADS
  • NO REPOSITIONING OF PATIENTS AND WORRY OF COMPRESSION OF NERVES ETC

POSITION

BARTS FLANK FREE POSITION

  • 2 3 L SALINE BAGS
  • 1 BELOW THE SHOULDER BLADES AND 1 BELOW THE PELVIS
  • PUT PATIENT IN LITHOTOMY FIRST WITH YELLOW FINS

UNDERSTAND THE ANATOMY

  • Theatre set up
  • i/i comes from opposite site
  • All screen on the same side as i/i i.e i/i screen and edoscopy stack
  • Anaes must push their machine slightly away and sit on one side.
  • I dont use USG

DRAPING

  • Use standard lithotomy procedure drapes and the PCNL drape
  • Equipment: all the same
  • Track formation: single stage dilatation
    • chiba, wire, 10fr straight, then co axial, the direct 30r amplatz and sheath

MAX BENEFIT

  • 2 SURGEONS
  • QUICK GA
  • 1 SURGEON SENDS UP ANGIO FOR RPG
  • 1 SURGEON ALREADY READY TO PUNCTURE
  • IF POSSIBLE THE RPG SURGEON WILL RECEIVE WIRE IN BLADDER AND PULL OUT FOR THRU AND THRU PROTECTION OF TRACK
  • WELCOME TO A PARADIGM SHIFT

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