The Split-leg Modified Lateral Position for Percutaneous Renal Surgery and Optimal Retrograde Access to the Upper Urinary Tract

OBJECTIVES To present our experience with percutaneous nephrolithotomy (PCNL) in the split-leg modified lateral position. MATERIAL AND METHOD The patient is placed with the thorax in the lateral position and the pelvis in an oblique position. Then the lower limbs are split and bent in the lowest position. Initial placement of a retrograde ureteral catheter, tract formation, stone fragmentation and retrieval, and optional extra procedures were accomplished with the patient in the same position. RESULTS PCNL in the split-leg modified lateral position resulted in decreased operating room time, less manipulation of the anesthetized patient, and maintaining the sterility of the retrograde ureteral catheter. In addition, it allowed simultaneous antegrade and retrograde endoscopic approach to the upper urinary tract. Ureteral catheter placement, PCNL, and associated procedures were possible in all patients. Adjunct procedures were internal urethrotomy, transurethral resection of the prostate, rigid and flexible ureteroscopy, and endopyelotomy or endopyeloplasty. CONCLUSIONS Performing PCNL in the split-leg modified lateral position has several advantages for the patient and the urologist, with greater versatility of stone manipulation along the entire urinary tract. UROLOGY 78: 217-220, 2011. (C) 2011 Elsevier Inc.