Modified Percutaneous Nephrolithotomy (PCNL)
Modified Percutaneous Nephrolithotomy (PCNL) without modified instruments is a groundbreaking percutaneous kidney stone technique developed by Mantu Gupta, MD, more than 10 years ago. Modified Percutaneous Nephrolithotomy (PCNL) without modified instruments allows the removal of very large kidney stones through a minimal incision and tract through the flank. We hope you enjoy this video demonstrating this technique in a patient with a very complex stone.
Compared to traditional PCNL, the size of the tract is 33% smaller and accomplishes complete stone removal with less bleeding, less pain, minimal risk of any complications, and a shorter, or no hospital stay. All the regular instruments that are used for a larger tract can be used for the smaller tract, while maintaining excellent visualization and use of traditional lithotripsy devices.
Modified PCNL is less invasive, being performed through an incision that is only 8 mm, so the vast majority of patients have no need for nephrostomy tubes, long-term indwelling stents, or catheters, and are discharged the same day or the next morning with no kidney stones. In addition, there are no stitches, and the access incision is sealed with glue.
In addition to Modified PCNL, Dr. Gupta is now performing Mini-PCNL, which is for medium sized kidney stones and involves an incision that is only 5 mm in size, and Supine PCNL, which is performed with a patient in supine instead of prone position, having the advantage of requiring less anesthesia and quicker recovery. Another recent advance is the use of ultrasound for gaining access to the kidney, thereby resulting in little to no exposure to ionizing radiation. In fact, select patients may be candidates for Outpatient Totally Tubeless Ultrasound Guided Supine Mini-PCNL, which takes advantage of all the advances above.
Professor of Urology
Icahn School of Medicine at Mount Sinai
Chair of the Department of Urology Mount Sinai West and Mount Sinai Morningside
Director of Endourology and Stone Disease
Mount Sinai Health System