Micro-percutaneous nephrolithotomy (micro-PNL) vs retrograde intra-renal surgery (RIRS): dealer's choice? The devil is in the details

"Microperc" micropercutaneous nephrolithotomy: a review of the literature

Recent years have seen innovations in working armamentarium of percutaneous nephrolithotomy (PCNL) leading to development of novel modifications such as miniperc, ultra miniperc, and microperc. Amongst these microperc appears to be least invasive and various authors, off late, have reported their experience with the technique. Literature on microperc was reviewed by a MEDLINE/PubMed search with articles in the English language since 2011 in published peer-reviewed journals. Articles comprised of case series, comparative, and noncomparative studies. Different facets encompassing the technique were analyzed including contemporary indications, technique and its modifications, outcomes, and comparison with other modalities. Technique is reported to be associated with high success rate (82-100%) and short hospital stay (1-2 days). Studies have reported minimal hemoglobin drop (0.1-1.4 gm%) and fewer complications of lower Clavien grades. Going small in PCNL has gone a long way to present day 4.85F puncture system. Utilization of this novel modification is on rise with larger case series and comparative analysis being reported in past 2 years. Technique boasts of high clearance rate, lower morbidity and short hospital stay. In the present era, this innovation in percutaneous stone management appears to be another milestone in quest for "knife to cannula to needle to nothing".