Advertisement

Endoscopic Combined IntraRenal Surgery (ECIRS): Rationale

  • Cesare Marco ScoffoneEmail author
  • Cecilia Maria Cracco
  • Roberto Mario Scarpa
Chapter

Abstract

The present chapter reviews the rationale of ECIRS (Endoscopic Combined IntraRenal Surgery), the logical evolution of PNL and of the old prone split-leg position. ECIRS would not exist without the Galdakao-modified supine Valdivia position, specifically supporting this versatile antero-retrograde approach to the upper urinary tract. ECIRS is a synergic approach in all its aspects, being a combination of retrograde intrarenal surgery (RIRS) and antegrade PNL and including essential intraoperative interactions among all operators (urologists, anaesthesiologists, nurses, scrub nurse, radiology technician, with the respective armamentaria), rigid and flexible instruments, endoscopes and accessories, intraoperative imaging techniques for renal puncture, ECIRS itself, and other surgical techniques. The anesthesiological, urological, and management advantages of ECIRS are described in detail.

References

  1. 1.
    Türk C, Knoll T, Koehrmann KU (2008) New guidelines for urinary stone treatment. Controversy or development? Urologe A 47:591–593Google Scholar
  2. 2.
    Guenther R, Alken P, Altwein JE (1978) Percutaneous nephro-pyelostomy applications and results. Rofo 128:720–726CrossRefGoogle Scholar
  3. 3.
    Alken P, Hutschenreiter G, Günter R, Marberger M (1981) Percutaneous stone manipulation. J Urol 125:463–466PubMedGoogle Scholar
  4. 4.
    Cracco CM, Scoffone CM, Scarpa RM (2011) New developments in percutaneous techniques for simple and complex branched renal stones. Curr Opin Urol 21:154–160PubMedCrossRefGoogle Scholar
  5. 5.
    Scoffone CM, Cracco CM, Cossu M et al (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54:1393–1403PubMedCrossRefGoogle Scholar
  6. 6.
    Cracco CM, Scoffone CM (2011) ECIRS (Endoscopic Combined IntraRenal Surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery? World J Urol 29:821–827PubMedCrossRefGoogle Scholar
  7. 7.
    Lehman T, Bagley DH (1988) Reverse lithotomy modified prone position for simultaneous nephroscopic and ureteroscopic procedures in women. Urology 32:529–531PubMedCrossRefGoogle Scholar
  8. 8.
    Kerbl K, Clayman RV, Chandhoke PS et al (1994) Percutaneous stone removal with the patient in the flank position. J Urol 151:686–688PubMedGoogle Scholar
  9. 9.
    Gofrit ON, Shapiro A, Donchin A et al (2002) Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol 16:383–386PubMedCrossRefGoogle Scholar
  10. 10.
    El-Husseiny T, Moraitis K, Maan Z et al (2009) Percutaneous endourologic procedures in high-risk patients in the lateral decubitus position under regional anesthesia. J Endourol 23:1603–1606PubMedCrossRefGoogle Scholar
  11. 11.
    Scarpa RM, Cossu FM, De Lisa A et al (1997) Severe recurrent ureteral stricture, the combined use of an anterograde and retrograde approach in the prone-split-leg position without X-rays. Eur Urol 31:254–256PubMedGoogle Scholar
  12. 12.
    Grasso M, Nord R, Bagley DH (1993) Prone split leg and flank roll positioning: simultaneous anterograde and retrograde access to the upper urinary tract. J Endourol 7:307–310PubMedCrossRefGoogle Scholar
  13. 13.
    Karami H, Rezaei A, Mohammadhosseini M et al (2010) Ultrasonography-guided percutaneous nephrolithotomy in the flank position versus fluoroscopy-guided percutaneous nephrolithotomy in the prone position: a comparative study. J Endourol 24:1357–1361PubMedCrossRefGoogle Scholar
  14. 14.
    Jang WS, Choi KH, Yang SC, Han WK (2011) The learning curve for flank percutaneous nephrolithotomy for kidney calculi: a single surgeon’s experience. Korean J Urol 52:284–288PubMedCrossRefGoogle Scholar
  15. 15.
    Ray AA, Chung DG, Honey RJ (2009) Percutaneous nephrolithotomy in the prone and prone-flexed positions: anatomic considerations. J Endourol 23:1607–1614PubMedCrossRefGoogle Scholar
  16. 16.
    Honey RJ, Wiesenthal JD, Ghiculete D et al (2011) Comparison of supracostal versus infracostal percutaneous nephrolithotomy using the novel prone-flexed patient position. J Endourol 25:947–954PubMedCrossRefGoogle Scholar
  17. 17.
    Lezrek M, Ammani A, Bazine K et al (2011) The split-leg modified lateral position for percutaneous renal surgery and optimal retrograde access to the upper urinary tract. Urology 78:217–220PubMedCrossRefGoogle Scholar
  18. 18.
    Shoma AM, Eraky I, El-Kenawy MR et al (2002) Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 60:388–392PubMedCrossRefGoogle Scholar
  19. 19.
    Ng MT, Sun WH, Cheng CW, Chan ES (2004) Supine position is safe and effective for percutaneous nephrolithotomy. J Endourol 18:469–474PubMedCrossRefGoogle Scholar
  20. 20.
    Steele D, Marshall V (2007) Percutaneous nephrolithotomy in the supine position: a neglected approach? J Endourol 21:1433–1437PubMedCrossRefGoogle Scholar
  21. 21.
    Falahaktar S, Moghaddam AA, Salhei M et al (2008) Complete supine percutaneous nephrolithotripsy comparison with the prone standard position. J Endourol 22:2513–2517CrossRefGoogle Scholar
  22. 22.
    Chedid Neto EA, Mitre AI, Mendes Gomes C et al (2007) Percutaneous nephrolithotripsy with the patient in a modified supine position. J Urol 178:165–168CrossRefGoogle Scholar
  23. 23.
    Valdivia Uria JG, Lanchars E, Villaroya S (1987) Percutaneous nephrolithectomy: simplified technique (preliminary report). Arch Esp Urol 40:177–180PubMedGoogle Scholar
  24. 24.
    Valdivia Uria JG, Valle GJ, Villaroya S (1990) Why is percutaneous nephroscopy still performed with the patient prone? J Endourol 4:269–272CrossRefGoogle Scholar
  25. 25.
    Valdivia Uria JG, Valle GJ, Lopez Lopez JA et al (1998) Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 160:1975–1978PubMedCrossRefGoogle Scholar
  26. 26.
    Arrabal-Polo MA, Arrabal-Martin M, Saz T, Paiz P (2011) Emergency percutaneous nephrostomy in supine-oblique position without cushion. Urol Res 39:521–522PubMedCrossRefGoogle Scholar
  27. 27.
    Xu KW, Huang J, Guo ZH et al (2011) Percutaneous nephrolithotomy in semisupine position: a modified approach for renal calculus. Urol Res 39:467–475PubMedCrossRefGoogle Scholar
  28. 28.
    Ibarluzea G, Scoffone C, Cracco CM et al (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde urological access. BJU Int 100:233–236PubMedCrossRefGoogle Scholar
  29. 29.
    Daels F, Gonzalez MS, Freire FG et al (2009) Percutaneous lithotripsy in Valdivia-Galdakao decubitus position: our experience. J Endourol 23:1615–1620PubMedCrossRefGoogle Scholar
  30. 30.
    Miano R, Scoffone C, De Nunzio C et al (2010) Position: prone or supine is the issue of percutaneous nephrolithotomy. J Endourol 24:931–938PubMedCrossRefGoogle Scholar
  31. 31.
    Hoznek A, Rode J, Ouzaid I et al (2012) Modified supine percutaneous nephrolithotomy for large kidney and ureteral stones: technique and results. Eur Urol 61:164–170PubMedCrossRefGoogle Scholar
  32. 32.
    Agah M, Ghasemi M, Roodneshin F et al (2011) Prone position in percutaneous nephrolithotomy and postoperative visual loss. Urol J 8:191–196PubMedGoogle Scholar
  33. 33.
    Akhavan A, Gainsburg DM, Stock JA (2010) Complications associated with patient positioning in urologic surgery. Urology 76:1309–1316PubMedCrossRefGoogle Scholar
  34. 34.
    Anusionwu IM, Wright EJ (2011) Compartment syndrome after positioning in lithotomy: what a urologist needs to know. BJU Int 108:477–481PubMedCrossRefGoogle Scholar
  35. 35.
    Edgcombe H, Carter K, Yarrow S (2008) Anaesthesia in the prone position. Br J Anaesth 100:165–183PubMedCrossRefGoogle Scholar
  36. 36.
    Ho JD, Dawes DM, Moore JC et al (2011) Effect of position and weight force on inferior vena cava diameter – implications for arrest-related deaths. Forensic Sci Int 212:256–259PubMedCrossRefGoogle Scholar
  37. 37.
    Rau CS, Liang CL, Lui CC et al (2002) Quadriplegia in a patient who underwent posterior fossa surgery in the prone position. J Neurosurg 96(1 Suppl):101–103PubMedGoogle Scholar
  38. 38.
    Tempelhoff R (2008) An optic nerve at risk and a prolonged surgery in the prone position. Anesthesiology 108:775–776PubMedCrossRefGoogle Scholar
  39. 39.
    De Sio M, Autorino R, Quarto G et al (2008) Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 54:196–203PubMedCrossRefGoogle Scholar
  40. 40.
    De La Rosette JJ, Tsakiris P, Ferrandino MN et al (2008) Beyond prone position in percutaneous nephrolithotomy: a comprehensive review. Eur Urol 54:1262–1269PubMedCrossRefGoogle Scholar
  41. 41.
    Liu L, Zheng S, Xu Y, Wei Q (2010) Systematic review and meta-analysis of percutaneous nephrolithotomy for patients in supine versus prone position. J Endourol 24:1941–1946PubMedCrossRefGoogle Scholar
  42. 42.
    Wu P, Wang L, Wang K (2011) Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. Int Urol Nephrol 43:67–77PubMedCrossRefGoogle Scholar
  43. 43.
    Arrabal-Martin M, Arrabal-Polo MA, Lopez-Leon V et al (2012) The oblique supine decubitus position: technical description and comparison of results with the prone decubitus and dorsal decubitus positions. Urol Res 40:587–592PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Cesare Marco Scoffone
    • 1
    Email author
  • Cecilia Maria Cracco
    • 1
  • Roberto Mario Scarpa
    • 2
  1. 1.Department of UrologyCottolengo HospitalTorinoItaly
  2. 2.Department of Urology, San Luigi HospitalUniversity of TorinoOrbassano, TorinoItaly

Personalised recommendations