Minimally invasive surgery via minimally invasive anesthesia Is laryngeal mask airway sufficient for supine percutaneous nephrolithotomy?

Abstract

Introduction: While endotracheal tube (ETT) is the traditional airway modality for percutaneous nephrolithotomy (PCNL), the adoption of supine positioning has opened the door for alternative strategies. Laryngeal mask airway (LMA) offers potential advantages, but its safety profile in supine PCNL remains understudied. This study aimed to compare urologic and anesthesia-related outcomes between LMA and ETT in patients undergoing ultrasound-guided supine PCNL.

Methods: In this retrospective study, 206 adult patients undergoing supine PCNL under general anesthesia between March 2023 and June 2024 were analyzed. Patients were grouped by airway modality: LMA (n=156) or ETT (n=50). Exclusion criteria included body mass index (BMI) >35 kg/m², American Society of Anesthesiologists (ASA) score ≥4, chronic obstructive pulmonary disease (COPD), pregnancy, or incomplete data. Urologic outcomes included intraoperative complications, 30-day complications, and postoperative pain. Anesthesia-related outcomes included hemodynamic instability, post-anesthesia care unit (PACU) stay, airway placement/removal times, and anesthesia-related complications. Outcomes were compared between the groups, and multivariable regression and sensitivity analysis were used to adjust for confounders.

Results: Overall complications were significantly lower in the LMA group (13% vs. 28%, p=0.01), and LMA was negatively associated with them in univariable analysis (odds ratio [OR] 0.378, 95% confidence interval [CI] 0.174-0.821, p=0.01). LMA use remained independently associated with a reduced risk of overall anesthetic and urologic complications after ad-hoc adjustments for preoperative risk factors, stone characteristics, and intraoperative factors. Airway placement and removal times were shorter in the LMA group; otherwise, no significant differences were observed in anesthesia-related outcomes. No procedures were aborted or converted due to airway complications.

Conclusions: In our limited study, LMA seems to be a safe and effective alternative to ETT for airway management in appropriately selected patients undergoing supine PCNL. Prospective, randomized studies are needed to confirm these findings.