ECIRS (Endoscopic Combined Intrarenal Surgery) Versus Fluoroscopic-guided Renal Access during supine Percutaneous Nephrolithotomy (PCNL): A Comparative Study

Stylianos Kontos, Athanasios Papatsoris, Sarath K Nalagatla


Objective: To evaluate the intra- and post-operative outcomes
of percutaneous renal access using either ECIRS (Endoscopic
Combined Intrarenal Surgery) or fluoroscopic-guided renal
access for supine percutaneous nephrolithotomy (PCNL).
Methods: In our institute, over a 24-month period (April 2012
to March 2014), two surgeons performed a total of 68 PCNLs
(not consecutive staghorn stone cases); 33 ECIRS and 35 fluoroscopically-
guided access (FGA). All patient and calculi demographics
were recorded, as well as intra-operative parameters
and complication/secondary procedure rates.
Results: We demonstrate that ECIRS offers rapid operating time
(total procedure time 113 vs. 142 min, p<0.05), low complication
rates (sepsis (0% vs. 5.8%), transfusion (0% vs. 8.6%) or
bowel injury (0%)), with reduced in-patient stay (2 vs. 4 days,
p<0.05) and high rates of stone clearance/residual fragments
<4mm (3% vs. 25.7%, p<0.05) and low rate of secondary
procedure (6.1% vs. 31.4%, p<0.05).
Conclusion: ECIRS offers shorter operating times, with low
complication rates, higher rates of stone clearance and a reduced
requirement for secondary procedures in comparison to purely
FGA. We envisage that this is due to a combination of quicker
and more accurate needle placement, as well as the ability to
perform concomitant FURS and laser stone fragmentation.


combined nephrolithotomy;renal puncture;learning curve

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