Simplified technique of patient positioning and renal access in true supine percutaneous nephrolithotomy

Objectives: To evaluate a novel, simplified technique for TRUE supine percutaneous nephrolithotomy (PCNL) that omits the use of bolsters or stirrups, utilizing a novel anatomical landmark (“Dixit line”) for initial puncture. The outcomes of this technique are compared with those of the traditional supine PCNL approach. Materials and Methods: A retrospective observational study was conducted on 400 patients who underwent supine PCNL for renal or upper ureteric stones between January 2020 and January 2024. All procedures were performed by a single urologist at a tertiary care center. Patients were divided into two groups: One treated with the novel technique and the other with the traditional technique. Data on demographics, stone characteristics, intraoperative variables, and postoperative outcomes were collected and analyzed. Results: The novel technique group demonstrated significantly shorter operative times (53 ± 10 min vs. 70 ± 15 min, P < 0.01), demonstrating enhanced procedural efficiency. Demographic and stone characteristics, as well as most intraoperative and postoperative outcomes, showed no significant differences between the two groups. However, the novel technique group exhibited a trend toward quicker discharge times (1.8 ± 0.5 days vs. 2.1 ± 0.7 days, P = 0.05). Conclusions: The novel TRUE supine PCNL technique, which excludes bolsters or stirrups and uses the “Dixit line” for initial puncture may serve as an effective alternative to traditional methods, improving efficiency while maintaining safety.