title: Developments in the technique of endoscopic combined intrarenal surgery in the prone split-leg position.
abstract: OBJECTIVE
  To develop a new technique for performing endoscopic combined intrarenal surgery in the prone split-leg position and to evaluate its efficacy using computed tomography.
  
  
  METHODS
  Between December 2010 and January 2013, 60 patients with large calculi (39.2 ± 2.6 mm) underwent this surgery. A laser fiber was used with a flexible ureteroscope introduced through a ureteral access sheath, and lithoclast lithotripsy was performed through a mini-percutaneous tract. Three-dimensional computed tomography was performed to determine anatomic variations, including the ureteral location and ureteropelvic junction angle in all patients in both the supine and prone positions.
  
  
  RESULTS
  All procedures were performed successfully with a single tract and the patient in the prone split-leg position. The mean surgical time was 120.5 ± 6.7 min. The initial stone-free rate was 82%, and the final stone-free rate was 87% after further treatment. One patient required blood transfusion, but none had severe complications. Computed tomography showed that the ureter between the orifice and ureteropelvic junction was straighter and the ureteropelvic junction angle was significantly smaller for surgeries conducted in the prone position than the supine position.
  
  
  CONCLUSIONS
  Flexible ureteroscopy in the prone split-leg position is a viable technique. It allows easy insertion of the ureteral sheath and access of the ureteroscope to the renal pelvis. The findings suggest that this hybrid surgery is an efficient, effective, and versatile procedure for the management of renal calculi.
authors.affiliation: Department of Urology, Toyota Kosei Hospital, Toyota, Japan; Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Hamamoto
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: yasui@med.nagoya-cu.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yasui
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okada
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Taguchi
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
authors.affiliation: Department of Urology, Toyota Kosei Hospital, Toyota, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Iwase
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Noriyasu
authors.initials: N
authors.lastname: Kawai
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tozawa
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kohri
mesh_terms: D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007431:Intraoperative Complications; D007668:Kidney / Q000601:surgery*; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D007834:Lasers; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods; D011183:Postoperative Complications; D016684:Prone Position; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014514:Ureteral Calculi / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods*