Suction-Assisted Mini-Percutaneous Nephrolithotomy: A Comprehensive Review of Technique, Outcomes, and Patient Positioning

Abstract

Background:  Percutaneous nephrolithotomy has long been the standard surgical approach for large and complex renal stones. Over the past two decades, miniaturization of instruments has led to the development of mini-percutaneous nephrolithotomy, which uses access sheaths of 14 to 20 French, offering the potential for reduced bleeding, less postoperative pain, and shorter hospital stay compared with the standard technique. However, mini-percutaneous nephrolithotomy is associated with elevated intrarenal pressure and longer operative duration due to limited fragment evacuation through the smaller sheath. The incorporation of suction-assisted sheaths during mini-percutaneous nephrolithotomy has emerged as a promising modification, applying continuous negative pressure to aspirate stone fragments and irrigant simultaneously, thereby lowering intrarenal pressure, improving intraoperative visibility, and accelerating stone clearance. In addition, patient positioning has evolved from the traditional prone approach toward supine and flank-free modified supine techniques, which provide advantages in airway management, cardiovascular stability, and the possibility of simultaneous retrograde access.