Transition from Prone to Supine Percutaneous Nephrolithotomy: Comparative Analysis of a Single Novice Surgeon's Initial 119 Prone Cases versus Subsequent 118 Supine Cases.

Abstract

Background: Percutaneous nephrolithotomy (PNL) is a gold-standard procedure for managing complex kidney stones. It is traditionally performed in the prone position. Supine PNL offers benefits, such as enhanced ergonomics and simultaneous retrograde surgery. This study evaluates the outcomes and learning curve of a single novice surgeon transitioning from 119 prone to 118 supine cases.

Methods: This retrospective analysis included 237 patients (119 prone and 118 supine) treated between 2017 and 2024. All procedures involved general anaesthesia, fluoroscopy-guided renal puncture and standard or mini-PNL operations. Outcomes, such as operation time, fluoroscopy time, stone-free rate, complication and hospital stay, were analysed.

Results: Patients in the supine group had more comorbidities and required more complex procedures (e.g., multi-tract access and mini-PNL) but exhibited significantly shorter operative times (98 versus 123 minutes, p < 0.001) and fewer complications (6.8% versus 19.3%, p = 0.009) than those in the prone group. First-month stone-free rates were comparable (75.2% supine versus 76.5% prone, p = 0.132), and the supine group had higher stone-free rates after additional intervention (88.9% versus 78.2%, p = 0.047). Transitioning to supine PNL demonstrated a smooth learning curve without increased fluoroscopy times or adverse events.

Conclusions: Transitioning from prone PNL to supine PNL is feasible. The process shortens the operative time and produce comparable stone-free rates. Future studies should explore learning curves for different approaches.