7° Congresso Nazionale

46
7° Congresso Nazionale Associazione Italiana di Endourologia
Table 3.
Comparison of results in blood loss in various nephrostomy tract techniques.
Technique Patients Ext. blood loss p (Miniperc vs all other)
Miniperc 63 (actual series) 0,65 ± 1,05 g/dL
Alken dilators 59 (previous series) 2,08 ± 1,43 g/dL < 0,001
One- Shot 36 (previous series) 1,64 ± 0,95 g/dL < 0,05
Pneumatic dilation 15 (previous series) 1,90 ± 1,12 g/dL < 0,02
for patients with Alken dilators access; 4,75 + 1,99 days
(range 2-13 days) for patients with One-Shot access;
4,46 + 1,06 days (range 3-7 days) for patients with pneumatic
dilation access; the data not reaches statistical significance,
but the mean hospital stay after miniperc procedures
seems shorter than after standard procedures.
CONCLUSIONS
Considering the literature that shows experiences mainly
in paediatric surgery with different nephrostomic
approach (reported range 11-24 Fr) it is opportune to
put a limit to the mini percutaneous procedure. We agree
to identifying “MINI perc” technique only to nephrostomic
approach ≤ 14 Fr and have manufactured the set
in accordance.
Superior approach cannot be intended Mini procedures
but just “MIDI”. Please consider that the main manufactures
of endourologic equipment are moving in accordance
with this line. In case of failure or operation difficulties
the approach can be easily converted and
increased to allow standard procedures.
The limits of this technique are: major operation times
and consequently major costs; more difficulties in vision
and operability. The advantages are: less trauma, reduction
of bleeding, possibility of tubeless procedures and
shorter recovery times.
Supine position is certainly a step forward in terms of
reducing operative times and percentage of clearance of
the fragments. In fact the LASER lithotripsy and the
decubitus allow litholopaxy of the fragments thanks to
the gravity and the retrograde continuous irrigation.
Moreover the possibility of using flexible ureteroscopes
allows a better access to all the kidney calices and consequently
an easier extraction of fragments.
We estimate, with the right indications, that the Miniperc
should be more and more adopted by modern endourol-
Archivio Italiano di Urologia e Andrologia 2007, 79, 3, Supplemento 1
ogists. The progress mainly in optics and the miniaturization
of instruments will make the procedure more
useful and effective.
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Correspondence: Stefania Ferretti M.D., Urology Unit, Azienda Ospedaliero-Universitaria of Parma, via Gramsci, 14 – 43100 Parma, Italy
E-mail: ferretti@ao.pr.it