Enhancing Percutaneous Access: The «GENOA» Prone Modified Position.

Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large or complex renal stones, but the optimal patient positioning remains debated. While the traditional prone position offers excellent access to posterior calyces, it can limit ventilation and increase anesthetic complexity. Supine modifications improve airway management but may reduce access efficacy. We propose the "GENOA" Prone Modified Position, a novel setup combining the advantages of both approaches. In this preliminary study, three patients underwent PCNL using this technique, which involves prone positioning with a ~30-45° rotation obtained by placing gel pads under the thoracic and abdominal regions contralateral to the affected kidney. This alignment brings the renal axis parallel to the floor, facilitating a safer and more ergonomic puncture. All punctures were performed below the costal margin, accessing the lower calyces in four of six renal units. Mean operative time was 72.2 minutes, and two patients achieved complete stone clearance. No complications or opioid use were recorded, and the average hospital stay was 4.3 days. The GENOA Prone Modified Position appears to be a feasible and effective solution that enhances access to posterior calyces while minimizing ventilatory risk. Further studies are needed to validate its reproducibility and long-term benefits in larger cohorts.