Comparación de los resultados hemodinámicos y respiratorios entre dos posiciones quirúrgicas para la nefrolitotomía percutánea: ensayo clínico prospectivo y aleatorizado / Comparison of hemodynamic and respiratory outcomes between two surgical positions for percutaneous nephrolithotomy: A prospective, randomized clinical trial

Introducción La nefrolitotomía percutánea (NLPC) se ha consolidado como el gold standard en el tratamiento de cálculos renales de gran tamaño y complejidad. Objetivos El objetivo de este estudio es evaluar la eficacia y la seguridad de la NLPC realizada en pacientes en posición de decúbito lateral frente a decúbito prono. Métodos En nuestro ensayo prospectivo aleatorizado, 60 pacientes programados para NLPC guiada por fluoroscopia y ecografía en decúbito prono o lateral se dividieron en dos grupos. Se compararon las características demográficas, los parámetros hemodinámicos, respiratorios y metabólicos, las puntuaciones de dolor postoperatorio, la necesidad de analgésicos, la cantidad de líquido administrado, la pérdida de sangre y las transfusiones, el tiempo quirúrgico y la estancia hospitalaria, y las complicaciones perioperatorias. Resultados Se determinó que la PaO2, la SaO2, la SpO2 y el índice de reserva de oxígeno (ORi) en el minuto60 del procedimiento y en el periodo postoperatorio, el índice de variabilidad pletismográfica (PVi) en el minuto60, la presión de distensión en todos los periodos de tiempo y el volumen del sangrado durante la intervención fueron superiores en el grupo de decúbito prono, de forma estadísticamente significativa. No hubo diferencias entre los grupos en cuanto a otros parámetros. Conclusiones Según nuestros resultados, la posición de decúbito lateral puede ser de preferencia en los procedimientos de NLPC, teniendo en cuenta que esta debe elegirse con base en la experiencia del cirujano, las características anatómicas y fisiológicas del paciente, los efectos positivos sobre los parámetros respiratorios y el sangrado, y que el tiempo quirúrgico puede disminuir al aumentar la experiencia (AU)

Introduction Percutaneous nephrolithotomy (PCNL) has become the gold standard for the treatment of large and complex kidney stones. Objectives The objective of this study is to evaluate the efficacy and safety of PCNL for patients in the flank position versus prone position. Methods In our prospective randomized trial, 60 patients who would undergo fluoroscopy and ultrasound-guided PCNL in prone or flank position were divided into two groups. Demographic features, hemodynamics, respiratory and metabolic parameters, postoperative pain scores, analgesic requirements, amount of fluid given, blood loss and transfusion, duration of operation and hospital stay, and perioperative complications were compared. Results PaO2, SaO2, SpO2 and oxygen reserve index (ORi) at the 60th minute of the operation and in the postoperative period, pleth variability index (PVi) at the 60th minute of the operation, driving pressure in all time periods and the amount of bleeding during the operation were determined to be statistically significantly higher in the prone group. There was no difference between the groups in terms of other parameters. Was found to be statistically significantly higher in the prone group. Conclusions Due to our results the flank position can be preferred in PCNL operations, considering that the position should be chosen according to the surgeon's experience, the patient's anatomical and physiological data, positive effects on respiratory parameters and bleeding, and the operation time can be shortened as the experience increases (AU)

Comparison of hemodynamic and respiratory outcomes between two surgical positions for percutaneous nephrolithotomy: a prospective, randomized clinical trial.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) has become the gold standard for the treatment of large and complex kidney stones. OBJECTIVES: The objective of this study is to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) for patients in the flank position versus prone position. METHODS: In our prospective randomized trial, 60 patients who would undergo fluoroscopy and ultrasound-guided PCNL in prone or flank position were divided into two groups. Demographic features, hemodynamics, respiratory and metabolic parameters, postoperative pain scores, analgesic requirements, amount of fluid given, blood loss and transfusion, duration of operation and hospital stay, and perioperative complications were compared. RESULTS: PaO2, SaO2, SpO2 and Oxygen Reserve Index (ORi) at the 60th minute of the operation and in the postoperative period, Pleth Variability index (PVi) at the 60th minute of the operation, driving pressure in all time periods and the amount of bleeding during the operation were determined to be statistically significantly higher in the prone group. There was no difference between the groups in terms of other parameters. Was found to be statistically significantly higher in the prone group. CONCLUSIONS: Due to our results the flank position can be preferred in PCNL operations, considering that the position should be chosen according to the surgeon's experience, the patient's anatomical and physiological data, positive effects on respiratory parameters and bleeding, and the operation time can be shortened as the experience increases.

V-NOTES hysterectomy under spinal anaesthesia: A pilot study.

Background: Spinal anaesthesia has not been widely adopted for laparoscopic surgeries until now. There are a few studies that have shown that spinal anaesthesia is at least as safe as general anaesthesia. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when V-NOTES surgery is performed under spinal anaesthesia. Objective: Combining V-NOTES with spinal anaesthesia to improve minimally invasive surgical techniques and provide maximum benefit to patients. Materials and Methods: Patients who were found to have benign pelvic organ pathologies, required a hysterectomy and were considered suitable for V-NOTES hysterectomy under spinal anaesthesia were included in this study. Spinal anaesthesia was achieved with 12.5 mg 0.5% hyperbaric bupivacaine in the sitting position. Perioperative events and complications related to spinal anaesthesia were noted. Postoperatively, the pain was evaluated using a visual analogue scale at the 6th, 12th, and 24th hours. Main outcome measures: To evaluate the feasibility and safety of spinal anaesthesia in VNOTES hysterectomy and to increase the advantages of minimally invasive surgical procedures. Results: No conversion to conventional laparoscopy or laparotomy was required in all six operated patients. Conversion from spinal anaesthesia to general anaesthesia was unnecessary, and no major perioperative incident occurred in any of the cases. Conclusion: In the current study by our team, we demonstrated that V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when VNOTES surgery is performed under spinal anaesthesia. What is new?: V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients.