# Tubeless Percutaneous Nephrolithotomy in the Barts ‘Flank-Free’ Modified Supine Position with 24-Hour Discharge: A Single-Center Experience

## TL;DR

This study shows that a modified supine position and tubeless technique in kidney stone surgery can allow patients to be discharged within 24 hours with good outcomes.

## Contribution

The study introduces a modified supine position and tubeless percutaneous nephrolithotomy technique for rapid patient discharge.

## Key findings

- 68.18% of patients were discharged within 24 hours after surgery.
- The tubeless technique was used in 90% of cases with a complication rate of 9.55%.
- Single-tract PCNL was performed in 94.55% of cases using the Barts ‘flank-free’ position.

## Abstract

Background and Objectives: To evaluate the effectiveness and outcomes of supine percutaneous nephrolithotomy (PCNL) using the Barts ‘flank-free’ position and ultrasound-guided puncture, assessing the feasibility of the tubeless technique for discharge within 24 h. Materials and Methods: We conducted a retrospective analysis of 208 patients across 220 renal units who underwent supine PCNL at a tertiary university hospital between May 2019 and December 2024. All procedures were performed by a single surgeon. Patient demographics, stone characteristics, and surgical outcomes were analyzed. The tubeless technique was applied in most cases, and outcomes were assessed in terms of operative time, complication rates, stone-free rates (SFRs), and length of hospital stay. Results: The mean operating time was 50.34 ± 30.80 min. Single-tract PCNL was performed in 94.55% of cases, with the tubeless technique used in 90% of patients. The overall complication rate was 9.55%, with no Clavien–Dindo grade IV–V complications observed. On the first postoperative day, 68.18% of patients were discharged, demonstrating 24 h discharge feasibility. SFR and complication rates aligned with existing literature. Conclusions: The Barts ‘flank-free’ position and ultrasound-guided puncture considerably improved surgical access and safety in supine PCNL. The tubeless technique facilitates faster recovery, making early discharge feasible, even with standard sheath sizes. Further research is warranted to validate these findings and optimize renal stone management outcomes.