Is supine position safe and effective for the percutaneous nephrolithotomy? Clinical experiences, tip and tricks in learning curve and PSAA technique

The aim of this study was to determine the factors facilitating the supine percutaneous nephrolithotomy technique in learning curve, to compare the supine and prone technique results. Material and methods: 47 patients who required percutaneous nephrolithotomy were included in this study, and they were divided into two groups as supine and prone. Prone technique was performed to 24 patients in the first group. In the second group, the supine technique was performed by calculating the patient-specific access angle for 23 patients. Demographic, preoperative, intraoperative, postoperative parameters, transfusion, and complications of both groups were compared. Results: Age, gender, side, stone size, stone-free rate, and length of stay in hospital were not statistically significant between the groups. Operation and fluoroscopy time were lower in the supine group, but it was not statistically significant. The decrease in hemoglobin was higher in the supine group and it was statistically significant (p = 0.027). The decrease in hemoglobin was not symptomatic in both groups. In addition, transfusion rates were similar and not statistically significant. Discussion: In previous studies, the supine technique was evaluated in terms of many factors. Process steps were tried to be standardized and improvements were made in the access technique. The supine technique, which uses patient-specific access angle, has similar complication rates as the prone technique. However, the operation and fluoroscopy times are shorter than the prone technique. For surgeons on the learning curve, the supine technique is safe, feasible, and has even shorter operating times with a patient-specific access angle.