Presented by: Victor Abdullatif DO
Ascension Macomb Oakland Hospital

Introduction

To compare our experience with minimally invasive Endoscopic Combined Intrarenal Surgery (mini-ECIRS) and standard percutaneous Endoscopic Combined Intrarenal Surgery (standard ECIRS) for stones of comparable size.

Materials

A stone database was queried for percutaneous stone-extraction procedures performed between July 2017 and May 2018 for stones between 8 and 33 mm from a free-standing ambulatory surgical center. Demographic profiles were adjusted and similar in both arms. Among the 120 procedures reviewed, 73 patients (61%) underwent standard ECIRS (34/30 Fr) and 47 patients (39%) underwent mini-ECIRS (17.5/15.5 Fr). Student’s t test was used for statistical analysis of quantitative variables, and χ² was used for qualitative variables.

Results

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Mean stone-free rate (SFR) was slightly higher in the standard ECIRS group compared to the mini-ECIRS group (97.2% vs 95.7%, respectively), but this difference was not statistically significant (p > 0.05). There were no statistically significant differences between mini-ECIRS and standard ECIRS in overall complications (6.4% vs 6.8%, respectively; p > 0.05). Additionally, there were no statistically significant differences in mean operative time (89 vs 91 mins; p = 0.655), renal access time (5 vs 5 mins; p = 0.691), intracorporeal time (36 vs 41 mins; p = 0.186), treatment time (16 vs 18 mins; p = 0.443), fluoroscopy time (75 vs 75 sec; p = 0.997), and PACU time (98 vs 96 mins, p = 0.834) between mini-ECIRS and ECIRS.

Conclusion

Mini-ECIRS is non-inferior to standard ECIRS and demonstrates comparable efficacy in the management of renal stones 8 to 33 mm in size, with a similar stone-free rates, complication rates, and operative time parameters. Our findings indicate that mini-ECIRS may be a suitable alternative to standard ECIRS in patients with a stone burden up to 33 mm as no significant difference between the two techniques was observed.

Funding

All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.

Lead Authors

Joel Abbott, DO, FACOS
Pacific West Urology

Julio Davalos, MD, FACS
Chesapeake Urology

Mark Silva, MD, FACS
Plymouth Care Center