Intraoperative complications: How to avoid them?

Abstract

At present, PNL is the minimally invasive technique of choice to treat complex renal stones. Despite being a safe surgical intervention, PNL is not exempt from potential complications, which can arise at any stage of the procedure: patient positioning, renal puncture, tract dilation, intraoperative manipulation, stone fragmentation and postoperative management. Besides being the majority of them minor, they can be kept to a minimum in experienced hands with the development of new techniques and improved technologies. However, patient positioning-related complications are not considered in any classification, as well as those related to anaesthesiological problems, which are the ones minimised adopting ECIRS in the Galdakao-modified supine Valdivia position. In particular, with regard to the potential complications due to decubitus, haemodynamic conditions, management of the respiratory tract and the relative location of the colon with respect to the puncture site, PNL performed in supine decubitus or in any of its variations proves to be safer than in prone decubitus.