Endoscopic combined intrarenal surgery (ECIRS): Rationale

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 fl exible 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.