title: Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient.
abstract: OBJECTIVE
  Morbidly obese or debilitated patients do not tolerate the prone position used for percutaneous nephrolithotripsy (PCNL) well and may suffer from severe cardiorespiratory compromise in this position. The purpose of this study is to demonstrate a simple way to overcome this difficulty.
  
  
  METHODS
  Two morbidly obese patients, ages 48 and 32 years, with Body Mass Indices of 47.5 and 43.2 and a 68-year old patient severely debilitated by multiple cerebral infarctions, ischemic heart disease, and kyphosis suffered from relatively high renal stone burdens. For PCNL, the patients were placed in the lateral decubitus position. To obtain an anteroposterior projection in this position, the C-arm fluoroscopy unit was tilted to one side and the operating table to the other. Tract dilation, stone fragmentation, and fragment extraction were performed with the patient in this position.
  
  
  RESULTS
  An attempt to perform PCNL in the prone position in the first patient was aborted because of severe hypoxemia and hypercarbia. In the lateral decubitus position, the procedures were easily performed in all patients without any complications. It was noted that by rotating the C-arm to a perpendicular position, it was possible to perform nephroscopy and use fluoroscopy simultaneously.
  
  
  CONCLUSIONS
  We highly recommend using the lateral position for PCNL in morbidly obese patients and in patients suffering from kyphosis. This position is safe and convenient.
authors.affiliation: Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel. ong1000@netvision.net.il
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Amos
authors.initials: A
authors.lastname: Shapiro
authors.forename: Yoel
authors.initials: Y
authors.lastname: Donchin
authors.forename: Allan I
authors.initials: AI
authors.lastname: Bloom
authors.forename: Ofer Z
authors.initials: OZ
authors.lastname: Shenfeld
authors.forename: Ezekiel H
authors.initials: EH
authors.lastname: Landau
authors.forename: Dov
authors.initials: D
authors.lastname: Pode
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000601:surgery*; D007738:Kyphosis / Q000150:complications; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011187:Posture; D016896:Treatment Outcome