Percutaneous Nephrolithotomy (PCNL) is a surgical procedure used to remove kidney stones that are too large or located in areas of the kidney that are difficult to access through less invasive methods. Here is a detailed overview of the PCNL procedure:

1. Patient Preparation:

• Before the procedure, the patient undergoes a thorough medical evaluation, including imaging studies such as CT scans, to determine the size, location, and number of kidney stones.

• The patient may be asked to stop certain medications, and fasting may be required before the surgery.

2. Anesthesia:

• PCNL is usually performed under general anesthesia, meaning the patient is completely asleep during the procedure.

3. Positioning:

• The patient is positioned on the operating table, often lying face down. This position provides the surgeon with direct access to the kidney.

4. Access to the Kidney:

• The surgeon makes a small incision or puncture in the skin on the patient's back to access the kidney.

• Using fluoroscopy (real-time X-ray guidance) or ultrasound, the surgeon locates the kidney stone within the kidney.

5. Guidewire Placement:

• A thin, flexible guidewire is passed through the incision and into the kidney. This guidewire serves as a guide for the subsequent steps.

6. Dilation of Tract:

• Over the guidewire, a series of dilators of increasing size are passed into the kidney to widen the access tract.

7. Nephroscope Insertion:

• A nephroscope, a tube with a light and camera at its tip, is inserted through the dilated tract. This allows the surgeon to visualize the kidney stone and surrounding structures.

8. Stone Fragmentation and Removal:

• Specialized instruments, such as laser fiber or pneumatic devices, are used to fragment the kidney stone into smaller pieces.

• The broken stone fragments are then removed through the nephroscope or suctioned out.

9. Placement of a Nephrostomy Tube:

• In some cases, a nephrostomy tube may be placed through the incision to drain urine from the kidney. This tube helps prevent postoperative complications and allows for better healing.

10. Closure:

• The incision is closed with sutures or a small dressing, depending on the surgeon's preference.

11. Postoperative Care:

• After the procedure, the patient is monitored closely in a recovery area.

• Pain management and hydration are important aspects of postoperative care.

• The nephrostomy tube, if placed, is typically removed after a day or two, depending on the patient's recovery.

12. Follow-up:

• Follow-up appointments and imaging studies are scheduled to ensure the complete removal of kidney stones and to monitor for any complications.

It's important to note that the specific details of the PCNL procedure may vary depending on the patient's individual case and the surgeon's preferences. The procedure has proven to be effective in treating large or complex kidney stones, providing patients with relief from symptoms and improving overall kidney function.