Minimally invasive endoscopic combined intrarenal surgery (ECIRS) for larger kidney stones is associated with stone-free and perioperative complication rates similar to those of standard ECIRS, according to a new study.

Compared with standard ECIRS using a 24 Fr access sheath for renal stones, the minimally invasive approach (mini-ECIRS) using a 16.5 Fr percutaneous access sheath decreased postoperative pain without increasing perioperative complications, a team led by Mitsuru Komeya, MD, reported in International Urology and Nephrology.

In a retrospective pilot study, Dr Komeya and colleagues compared 77 patients who underwent standard ECIRS with a matched group of 77 patients who underwent mini-ECRIS. Patients were matched by age, sex, history of febrile urinary tract infection, stone surface area (SSA), number of involve calyces, and staghorn calculi. The mean SSAs for the standard ECIRS and mini-ECIRS groups were 648 and 555 mm2, respectively. The study population as a whole had a mean stone diameter of 37.6 mm.

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The standard ECIRIS and mini-ECIRS groups did not differ significantly in stone-free rates (52.0% vs. 61.1%), rates of Clavien-Dindo grade 2 or higher perioperative complications (26.0% vs 19.5%), and rates of bleeding-related complication (6.5% vs. 2.6%). Two patients in each group experienced septic shock. The mini-ECIRIS procedure tended to reduce postoperative pain, according to the investigators.


Usui K, Komeya M, Taguri M, et al. Minimally invasive versus standard endoscopic combined intrarenal surgery for renal stones: a retrospective pilot study analysis [published online March 4, 2020]. Int Urol Nephrol.   doi: 10.1007/s11255-020-02433-x