Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure u

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large kidney stones. Here’s a general outline of the procedure: ### Preoperative Preparation: 1. **Evaluation**: - Comprehensive assessment through imaging (CT scan, X-ray, ultrasound) to determine the size, location, and type of kidney stone. - Blood tests and urine analysis to check kidney function and infection. - The patient is typically advised to fast for several hours before the surgery. 2. **Anesthesia**: - The procedure is performed under general anesthesia, though regional anesthesia may be used in some cases. ### Procedure Steps: 1. **Positioning**: - The patient is placed in a prone position (lying on the stomach), although the supine position (lying on the back) may be used in some cases. 2. **Access to the Kidney**: - A small incision (about 1 cm) is made in the skin, usually in the flank area (side of the abdomen). - A needle is inserted through the incision into the kidney under fluoroscopic or ultrasound guidance. - A guidewire is passed through the needle into the kidney's collecting system. 3. **Dilation of the Tract**: - The tract created by the guidewire is dilated using dilators, allowing the passage of a nephroscope. - A sheath is inserted over the guidewire to maintain access and protect surrounding tissues. 4. **Stone Removal**: - The nephroscope is inserted through the sheath to visualize the stone. - The stone is broken up into smaller pieces using ultrasonic, laser, or pneumatic lithotripsy devices. - Stone fragments are removed using graspers or suction. 5. **Post-Removal Assessment**: - The surgeon checks for any remaining stone fragments and ensures that the collecting system is clear. 6. **Placement of a Nephrostomy Tube**: - A nephrostomy tube (a drainage tube) may be left in place to ensure proper drainage of urine and any residual stone fragments from the kidney. - In some cases, a