Percutaneous nephrolithotomy or nephrolithotripsy
| Anesthesia type |
General |
|---|---|
| Airway |
LMA or ETT |
| Lines and access |
20G+ IV |
| Monitors |
Standard, 5-lead EKG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Lateral positioning |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A percutaneous nephrolithotomy or nephrolithotripsy is a surgical procedure performed to remove kidney stones through a small incision in the back.
Overview
Indications
These procedures are treatments for kidney stones that are used in patients with large or irregularly shaped kidney stones, people with infections, stones that have not been broken up enough by SWL (extracorporeal shock wave lithotripsy) or those who are not candidates for another common stone treatment, ureteroscopy. Stones that are bigger than 2 cm (the size of a marble) require this procedure.[1]
This is what the words mean:
- Percutaneous means through the skin
- Nephrolithotomy is a combination of the word roots nephro- (kidney), litho-(stone), and -tomy (removal)
- Nephrolithotripsy is a combination of the word roots nephro- (kidney), litho (stone), and -tripsy (crushed)[1]
Surgical procedure
Both procedures involve entering the kidney through a small incision in the back. Once the surgeon gets to the kidney, a nephroscope (a miniature fiberoptic camera) and other small instruments are threaded in through the hole. lf the stone is removed through the tube, it is called nephrolithotomy. lf the stone is broken up and then removed, it is called nephrolithotripsy. The surgeon can see the stone, use high frequency sound waves to break up the stone, and "vacuum" up the dust using a suction machine.[1]
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | LMA vs ETT. Consider positioning, BMI, pulmonary physiology |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Standard setup with 1 IV
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Standard monitoring
1 good IV
Induction and airway management
Consider ETT > LMA based on patient position and case length
Positioning
Sloppy Lateral
Maintenance and surgical considerations
Adequate depth to prevent bucking if in lithotomy
Emergence
Postoperative management
Disposition
Outpatient vs inpatient
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ 1.0 1.1 1.2 "Percutaneous Nephrolithotomy /Nephrolithotripsy". National Kidney Foundation. 2016-01-07. Retrieved 2022-07-14.
Top contributors: Jashvin Patel and Chris Rishel