Introduction: Standard antegrade percutaneous nephrolithotomy (PCNL) has long been an effective treatment option for moderate to large renal stones. The miniaturization of endoscopic instrumentation has led to the emergence of mini-PCNL as an increasingly popular option. For established practitioners unfamiliar with mini-PCNL or trainees exposed to these procedures for the first time, formal educational resources to shorten the learning curve are lacking. In this video, we present our technique for prone mini-PCNL, including obtaining direct vision ureteroscopically-guided access, dilating the access tract, facilitating efflux of fragments, placing a ureteral stent, and performing an intercostal nerve block. Methods: Footage from four prone mini-PCNL cases was collected for editing and review. All were performed at a single academic institution under the supervision of the same attending physician to standardize technique across cases. Apple Imovie was used to edit video clips and create a cohesive educational step-by-step instructional video for trainees and attending physicians performing this procedure. In particular, the video describes a novel and technically simple technique for attaining “through-and-though” antegrade percutaneous access via a retrograde ureteroscopic approach and highlights helpful tips and tricks for optimizing a successful and efficient procedure. Results: All patients underwent successful mini-PCNL without complications. All were discharged the same day with a ureteral stent and strings, which was removed by the patient within one week after surgery. The educational video was disseminated throughout our residency program for review by residents prior to participating in their first mini or standard PCNL procedure. Conclusions: Mini-PCNL can be used effectively for cases of moderate sized stones in which ureteroscopy may prove tedious, while improving stone-free rates, shortening operative times, and preserving same day discharge. Our educational video provides an easy, step-by-step process for trainees and attending physicians to shorten their learning curve and maximize success for their next mini-PCNL stone procedure. SOURCE OF Funding: None
