An easy alternative technique for percutaneous nephrolithotomy with laparoscopic trocar and ultrasound guiding: safety and effectiveness in rural area setting.

Purpose: Percutaneous nephrolithotomy (PCNL) is an effective treatment for large kidney stones, but wider access paths increase the risk of bleeding. While modern miniaturized PCNL techniques reduce invasiveness, they can compromise stone fragment clearance. This study aims to evaluate the efficacy and safety of a novel PCNL technique utilizing pediatric trocar laparoscopy to enhance visualization and potentially minimize blood loss.

Methods: A single-centered prospective study was conducted at Sultan Agung Islamic Hospital, Semarang, Indonesia, between July and September 2024. Patients with large kidney stones underwent a novel technique replacing PCNL after obtaining informed consent. The primary endpoints measured were stone-free rate and major complications after the procedure.

Results: Forty-four participants were enrolled in this study, with 41 completing it. The 24-hour stone-free rate was 87.8%, improving to 100% at 30 days. The mean operative time was 42 ± 13.6 min, with an average hospital stay of 2.39 ± 0.81 days. No major complications were reported. The mean hemoglobin drop was minimal, and transient postoperative leukocytosis without clinical infection was observed.

Conclusion: This study suggests that a novel technique for treating large kidney stones using a 3.5 mm laparoscopic trocar in PCNL is considered an effective and safe procedure as an alternative to the standard PCNL procedure.