Percutaneous nephrolithotomy or nephrolithotripsy

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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
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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. 1.0 1.1 1.2 "Percutaneous Nephrolithotomy /Nephrolithotripsy". National Kidney Foundation. 2016-01-07. Retrieved 2022-07-14.