ABSTRACT
Introduction &Objective: In the ongoing Covid-19 era where physical distancing is utmost important, we assessed the feasibility of ambulatory tubeless supine mini-PCNL under spinal anaesthesia for stone size between 1.5 - 3 cm to minimise hospitalisation. Method(s): Between June 2020 to August 2021, total 284 patients underwent PCNL out of which 122 underwent ambulatory tubeless mini-PCNL. The inclusion criteria were those consented for study, size of the stone 1.5 - 3 cm, pre-operative Covid-19 negative test (CT-chest and RT-PCR). Those excluded were with solitary kidney, morbidly obese, active UTI, congenital abnormalities. Patient's demographics, peri-operative parameters, stone free rate, blood loss, pleural complications and requirements of auxiliary procedures were prospectively evaluated Results: All the patients underwent supine mini-PCNL in FOSML (Flank-Oblique Supine Modified Lithotomy) position through a single tract of size 14/16 Fr. In, 18 (15%) patients' additional tracts were made for inaccessible secondary stones. Holmium laser and pneumatic source of energy were used for fragmentation of stones. Supra 12th rib tracts were made in 23 (19%) patients while in remaining 99 (81%) had infra-costal tracts. Complete SFR (stone-free rate) was achieved in 112 (92%) under fluoroscopy and the remaining 10 (8%) needed auxiliary procedure to render stone free. Average total operative time was 44 +/- 15 minutes and no nephrostomies were placed. All patients were discharged within 24 hours of operation with only 7 (6%) patients required readmission within 48 hours of discharge with hematuria and were managed conservatively. No other major complications occurred except for mild fever in few. Conclusion(s): Ambulatory supine tubeless mini-PCNL under spinal anaesthesia is safe and effective in this uncertain rapidly spreading COVID-19 era to minimise hospitalisation. It should be recommended whenever feasible, and it is easy to adapt to this newer approach especially for urologist already performing supine PCNL.