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This randomized clinical trial will compare four ventilation strategies during retrograde intrarenal surgery performed under general anesthesia. The study aims to determine whether reducing respiratory-related kidney movement improves surgical success and decreases perioperative complications. Eighty adult patients will be randomly assigned to standard ventilation, hypoventilation, intermittent apnea ventilation, or one-lung ventilation. Surgical outcomes and perioperative complications will be compared between groups.
Retrograde intrarenal surgery is commonly performed under general anesthesia, but respiratory movement may interfere with kidney stability during the procedure. This prospective, randomized, single-center trial will compare standard ventilation, hypoventilation, intermittent apnea ventilation, and one-lung ventilation in adult patients undergoing retrograde intrarenal surgery. The primary objective is to determine whether different ventilation strategies improve surgical success by reducing kidney movement. Secondary outcomes include operative time, stone access time, fluoroscopy time, laser use time, complications, length of hospital stay, and postoperative stone-free rate.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Ventilation | Active Comparator | Patients will receive standard volume-controlled mechanical ventilation during retrograde intrarenal surgery under general anesthesia. |
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| Hypoventilation | Experimental | Patients will receive hypoventilation with reduced tidal volume and respiratory rate during retrograde intrarenal surgery under general anesthesia. |
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| Intermittent Apnea Ventilation | Experimental | Patients will receive intermittent apnea periods during selected surgical steps, in coordination with the surgeon. |
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| One-Lung Ventilation | Experimental | Patients will receive one-lung ventilation during selected surgical steps, in coordination with the surgeon. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard Ventilation | Procedure | Volume-controlled mechanical ventilation using standard ventilator settings during general anesthesia. |
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| Measure | Description | Time Frame |
|---|---|---|
| Kidney Motion During Retrograde Intrarenal Surgery | Kidney motion during surgery will be evaluated and compared among the four ventilation strategies. | During surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Stone-free Rate | Percentage of patients who are stone-free after retrograde intrarenal surgery. | Postoperative Day 30 |
| Operative Time | Total duration of surgery measured from the beginning to the end of the surgical procedure. |
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Inclusion Criteria:
Age 18-75 years. ASA physical status I-III. Scheduled for elective RIRS/RIRC under general anesthesia. No obstructive or restrictive pulmonary disease. No history of pneumothorax. No pulmonary mass or other significant respiratory disease. Normal coagulation parameters and not receiving antithrombotic therapy. No active urinary tract infection. Written informed consent.
Exclusion Criteria:
Age <18 or >75 years. ASA IV. Obstructive or restrictive pulmonary disease. History of pneumothorax. Pulmonary mass or significant respiratory disease. Receiving antithrombotic therapy or abnormal coagulation. Active urinary tract infection or urinary tract anatomical abnormality. Refusal or inability to provide informed consent.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Tuna Ertürk, MD | Contact | +905325010066 | tunaerturk22@yahoo.com | |
| Hakan Emirkadı, MD | Contact | +905322609367 | suheylaatay81@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Tuna Ertürk, MD | University of Health Sciences Sultan 2. Abdulhamid Han Training and Research Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sultan Abdulhamid Han Training and Research Hospital | Istanbul | Istanbul | 34668 | Turkey (Türkiye) |
Individual participant data will not be made publicly available to protect participant confidentiality.
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Participants will be randomly assigned to one of four parallel ventilation strategy groups.
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| Hypoventilation | Procedure | Volume-controlled mechanical ventilation using reduced tidal volume and respiratory rate during general anesthesia. |
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| Intermittent Apnea Ventilation | Procedure | Intermittent apnea periods applied during selected stages of retrograde intrarenal surgery to reduce kidney motion. |
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| One-Lung Ventilation | Procedure | One-lung ventilation applied during selected stages of retrograde intrarenal surgery to reduce kidney motion. |
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| During surgery |
| Fluoroscopy Time | Total fluoroscopy exposure time recorded during the procedure. | During surgery |
| Laser Activation Time | Total duration of laser use during stone fragmentation. | During surgery |
| Perioperative Complications | Occurrence of intraoperative and postoperative complications. | Periprocedural |
| Length of Hospital Stay | Number of days of hospitalization. | Periprocedural |
| ID | Term |
|---|---|
| D007669 | Kidney Calculi |
| D053040 | Nephrolithiasis |
| ID | Term |
|---|---|
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052878 | Urolithiasis |
| D014545 | Urinary Calculi |
| D052801 | Male Urogenital Diseases |
| D002137 | Calculi |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D061810 | One-Lung Ventilation |
| ID | Term |
|---|---|
| D012121 | Respiration, Artificial |
| D058109 | Airway Management |
| D013812 | Therapeutics |
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