Outcomes of a Single Transverse Chest Roll for Prone Positioning Technique During Percutaneous Nephrolithotomy

Objective: To compare anesthetic parameters using a novel prone single transverse chest roll technique (STR) to the standard thoraco-pelvic dual transverse roll technique (DTR).

Methods: A retrospective review of 441 patients who underwent PCNL between 2018 and 2022 was performed. A total of 4 surgeons were included-surgeon 1 utilized the STR technique while surgeons 2, 3, and 4 used the DTR technique. Anesthetic parameters including end-tidal CO (ETCO), mean arterial pressure (MAP), peak airway pressure (P), plateau airway pressure (P), positive end-expiratory pressure (PEEP), oxygen saturation (SpO), and tidal volume (TV) were compared between both groups at 0 (supine), 15-, 30-, and 60-minute post-intubation intervals. Mixed effects regression models with interaction and pairwise comparisons were made between both groups (P <.05).

Results: A total of 581 PCNLs were performed with 199 using STR and 382 using DTR. Surgery duration, ASA class, and age were similar amongst the STR and DTR groups. Estimated blood loss (59cc vs 83cc, P = .007) and length of stay (77 hrs vs 163 hrs, P = <.001) was significantly lower in the STR group. There was a significantly lower P, P and TV in the STR compared to DTR group at 0, 15, 30, and 60 minutes (P <.001).

Conclusion: Usage of a single transverse chest roll during prone PCNL appears to be a safe positioning method. STR patients had lower P and P at all time points, which has been shown to be predictive of lower blood loss.