Does tidal volume during mechanical ventilation affect pediatric retrograde intrarenal surgery outcomes?

Purpose: The aim of the study was to analyze the effect of tidal volume during mechanical ventilation (MV) on pediatric retrograde intrarenal surgery (RIRS) outcomes.

Methods: The data of patients who underwent RIRS between January 2018 and January 2023 were retrospectively analyzed. Patients under the age of 18 who underwent RIRS and whose data were available were included in the study. Patients were divided into two groups, ≤ 7 ml/kg (Group 1) and > 7 ml/kg (Group 2), according to the tidal volume during MV. Demographic data, clinical characteristics, and perioperative and postoperative data of the patients were statistically compared in both groups.

Results: A total of 83 patients were enrolled, with a mean age of 6.9 ± 4.5 (1-17) years and a mean stone size of 11.7 ± 5.4 (5-33) mm. There were 31 patients in Group 1 and 52 patients in Group 2. The demographic data and clinical characteristics of the patients in both groups were comparable. There was no statistically significant difference between the two groups regarding stone-related (side, size, density, number, and location) and surgical (access sheath and basket use, operation time, fluoroscopy time, or postoperative stenting rates, complication rates) parameters. In the first month, the stone-free rate was higher in Group 1 than in Group 2 (90.3% vs. 71.1%, p = 0.03). No high-grade or anesthesia-related complications were observed in any of the patients.

Conclusion: Reducing tidal volume in pediatric RIRS may improve the stone-free rate by facilitating laser targeting and increasing operative field stability and surgical comfort.