Presentation Authors: Mark V. Silva MD, Meagan M. Dunne MD*, Joel E. Abbott DO, Julio G. Davalos MD, Baltimore, MD
Introduction: Percutaneous Nephrolithotomy (PNL) is a procedure that has traditionally been performed in an inpatient setting with at least an overnight stay. Many surgical procedures have evolved over time from an inpatient setting to an ambulatory surgery center (ASC) setting. Feasibility of Ambulatory PNL (aPNL) was shown in our initial pilot series of 25 cases . This 420 case series is reviewed to further evaluate outcomes with a more robust data set.
Methods: We present our initial series of 420 patients who underwent PNL in an ASC from April 2015 to October 2018. Each aPNL was performed by one of two surgeons with the same operative team. All procedures were performed with the operative surgeon obtaining renal access and all procedures were performed tubeless (ureteral stent without a nephrostomy tube). All patients also had hemostatic plugs placed into the access tract with a local intercostal block performed to aid with pain control. All cases were reviewed and demographic data and case details were analyzed.
Results: Our initial 420 consecutive aPNL cases were reviewed, identifying 192 men and 228 women, 202 right side and 218 left, one bilateral, mean age 57.2 years (16-86), mean BMI 30.6 (16-49), mean ASA of 2.3 (range 1-4) and mean stone burden 30.4 mm (5-140mm), mean fluoroscopy time 86 sec (0-299). Mean OR time was 105 min (range 32-305 min). Mean PACU time was 98 min (range 37-240 min). A mini-PCNL procedure was conducted in 80 (23%) patients. Stone free rate was 83%. Twenty patients had complications ranging from Clavien I-IVa, of which 12 were hospital transfers.
Conclusions: This consecutive 420 case series further demonstrates the safety of aPNL. While twenty patients experienced complications, the site of service did not lead to an alteration in the outcomes of the adverse events. Each complication that occurred was managed in an appropriate fashion without notable treatment delay. Our complication rate in the ASC is lower than reported in large cohort studies and lower than our hospital based patient population, however recognizing these patients are preselected. With an experienced surgeon, well trained operative team and with modifications to the procedure focusing on post-operative pain control, PNL can be safely and effectively performed in an ASC. _x000D_
1. Davalos JG, Abbott JE. Ambulatory PCNL: Initial Case Series. J Urology. April 2016. Vol. 195 (4), Supplement 1: MP51-20, e688-e689. 22. Abbott JE, Cicic, A, Jump III RW, Davalos JG. Hemostatic Plug: Novel Technique for Closure of Percutaneous Nephrostomy Tract. J Endourol. March 2015, 29(3): 263-269.