What is it ?
Percutaneous NephroLithotomy (PCNL) is that the most well-liked technique for treating larger kidney stones (over 2cm in diameter) placed inside the kidney. It involves keyhole surgery that’s performed through a 1cm incision within the skin A mini-PERC is comparable in approach, however represents a refinement within the technique because of having smaller cameras, higher stone lasers and specialised tools. The incision that’s created within the skin is way smaller and allows for faster patient recovery and results in a safer procedure.
The purpose of PCNL is the removal of renal calculi in order to relieve pain, bleeding into or obstruction of the urinary tract, and/or urinary tract infections resulting from blockages. Kidney stones range in size from microscopic groups of crystals to objects as large as golf balls. Most calculi, however, pass through the urinary tract without causing problems.
Renal calculi are formed when the urine becomes supersaturated (overloaded) with mineral compounds that can form stones. This supersaturation may occur because the patient has low urinary output, is excreting too much salt, or has very acid urine. Urolithiasis is the medical term for the formation of kidney stones; the word is also sometimes used to refer to disease conditions associated with kidney stones.
What are the advantages?
- Allows for large or complicated stones to be treated in a minimally invasive fashion, which in the past this would have necessitated a large incision, and longer hospital stay.
- Hospital stay is now 2-4 days, and the out of hospital recovery time is significantly shorter than the traditional open surgical approaches.
- Quicker return to work.
What are the disadvantages?
- Compared to traditional techniques in dealing with large complex stones, there are no disadvantages.
- Improvements in techniques and equipment have allowed this type of surgery to be carried out more safely amongst subspecialty trained surgeons.
While you are under the general anaesthetic the surgeon will examine your bladder with a long, thin, semi-rigid or flexible telescope and pass a small tube up to your kidney, which has the stone. This is used to pass a mixture of a coloured dye and x-ray dye to the kidney making it easier to see during the operation.
You will then be placed face down on the operating table and the consultant will make one or more small incisions into your back. This is done using special metal or balloon dilators (see diagram). This enables the consultant to pass a telescope into your kidney.
The stone or stones in the kidney are then removed either intact or in pieces after breaking them with special instruments. X-rays will be taken during and at the end of the procedure to ensure that all accessible bits of the stone have been removed from your kidney.
A telescope is passed down into the kidney so that the surgeon can see the stone.
The stone is broken up and then the pieces are removed using a special instrument.
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