Minimally invasive surgery via minimally invasive anesthesia

Is laryngeal mask airway sufficient for supine percutaneous nephrolithotomy?

Authors

  • Ziv Savin Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Jeannette Mullins Department of Anesthesiology, Perioperative, & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • Yuval Elkun Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Asher Mandel Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Eve Frangopoulos Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Vinay Durbhakula Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Campbell Vogt Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Linda Dayan Rahmani Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Aubrey Dibello Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Esther Kim Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Adam Daniel Geffner Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Blair Gallante Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • William M. Atallah Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • Raj M. Parekh Department of Anesthesiology, Perioperative, & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • Mantu Gupta Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

DOI:

https://doi.org/10.5489/cuaj.9559

Keywords:

Percutaneous nephrolithotomy, Anesthesia, Laryngeal Mask Airway, Endotracheal tube, Complications

Abstract

Introduction: While endotracheal tube (ETT) is the traditional airway modality for percutaneous nephrolithotomy (PCNL), the adoption of supine positioning has opened the door for alternative strategies. Laryngeal mask airway (LMA) offers potential advantages, but its safety profile in supine PCNL remains understudied. This study aimed to compare urologic and anesthesia-related outcomes between LMA and ETT in patients undergoing ultrasound-guided supine PCNL.

Methods: In this retrospective study, 206 adult patients undergoing supine PCNL under general anesthesia between March 2023 and June 2024 were analyzed. Patients were grouped by airway modality: LMA (n=156) or ETT (n=50). Exclusion criteria included body mass index (BMI) >35 kg/m², American Society of Anesthesiologists (ASA) score ≥4, chronic obstructive pulmonary disease (COPD), pregnancy, or incomplete data. Urologic outcomes included intraoperative complications, 30-day complications, and postoperative pain. Anesthesia-related outcomes included hemodynamic instability, post-anesthesia care unit (PACU) stay, airway placement/removal times, and anesthesia-related complications. Outcomes were compared between the groups, and multivariable regression and sensitivity analysis were used to adjust for confounders.

Results: Overall complications were significantly lower in the LMA group (13% vs. 28%, p=0.01), and LMA was negatively associated with them in univariable analysis (odds ratio [OR] 0.378, 95% confidence interval [CI] 0.174−0.821, p=0.01). LMA use remained independently associated with a reduced risk of overall anesthetic and urologic complications after ad-hoc adjustments for preoperative risk factors, stone characteristics, and intraoperative factors. Airway placement and removal times were shorter in the LMA group; otherwise, no significant differences were observed in anesthesia-related outcomes. No procedures were aborted or converted due to airway complications.

Conclusions: In our limited study, LMA seems to be a safe and effective alternative to ETT for airway management in appropriately selected patients undergoing supine PCNL. Prospective, randomized studies are needed to confirm these findings.

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Published

2026-07-07

How to Cite

Savin, Z., Mullins, J., Elkun, Y., Mandel, A., Frangopoulos, E., Durbhakula, V., … Gupta, M. (2026). Minimally invasive surgery via minimally invasive anesthesia: Is laryngeal mask airway sufficient for supine percutaneous nephrolithotomy? . Canadian Urological Association Journal, 20(10). https://doi.org/10.5489/cuaj.9559

Issue

Vol. 20 No. 10 (2026): CUAJ October

Section

Original Research

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