Investigate the Renal Movement by Single Lung Ventilation in Patients Administered RIRS for Kidney Stones.

Study Overview
=================
Brief Summary
-----------------
In patients undergoing RIRS for kidney stone, we aim to show the effect of single lung ventilation with a double lumen tube on operative (operation scope duration, perforation, hemorrhage, etc. complications) and postoperative parameters (stone-free rates, complications like postoperative hemorrhage and fever, hospital stay, etc.) and to show changes in renal stone position during simultaneous normal ventilation and single lung ventilation.

Detailed Description
-----------------
In recent years open surgical treatment has changed to minimal invasive treatments for kidney stone treatment. Additionally, the treatment choices vary depending on the localization of the stone and its dimensions. In the European Urology Association (EUA) guidelines, it states the RIRS method can be used to treat stones up to 2 cm in the kidney. Due to RIRS the operation and scopy durations and hospital stay have clearly reduced compared to the standard treatment of percutaneous nephrolithotomy. However, the high hydrostatic pressure applied to the renal pelvis during RIRS may cause unwanted results in the postoperative period such as hydronephrosis and loss of renal parenchyma. During the operation, the stone may move during deep inspirium and expirium sequences linked to deep ventilation which may lengthen the operation and scope durations and brings risks such as perforation during laser lithotripsy application. In this study we aimed to apply single lung ventilation during the operation (one of the indications for single lung ventilation is to increase surgical view and ease manipulation) to minimize renal movement on that side and reduce peroperative and postoperative complications.

Official Title
-----------------
To Investigate the Effect of Reducing Renal Movement by Single Lung Ventilation in Patients Administered Retrograde Infrarenal Surgery (RIRS) for Kidney Stones on Operative and Postoperative Parameters

Conditions
-----------------
Perioperative/Postoperative Complications, Kidney Stone

Intervention / Treatment
-----------------
* Diagnostic Test: Preoperative Parameters
* Other: Peroperative Parameters
* Other: Postoperative Parameters
* Other: Movement of kidney
* Procedure: single lung ventilation
* Procedure: standard ventilation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Older than 18 years ASA (American Society of Anesthesiologists) 1-3 Patients with 2-3 cm stones in kidneys Exclusion Criteria: Patients with staghorn stones in kidneys Patients with urinary system anomalies Removal Criteria : Difficult airway Patients with carinal, bronchial lesions Patients with bad general situation Patients younger than 18 years Satiated patients

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Patients given single lung ventilation<br>The first group will have single lung ventilation applied to ensure reduction. Preoperative Parameters : Hmg, serum creatinine levels Peroperative Parameters : Scope duration, perforation, hemorrhage, etc. complications) Postoperative parameters (stone-free rates, complications like postoperative hemorrhage and fever, hospital stay, etc) Movement of kidney : Changes in renal stone position during simultaneous normal ventilation and single lung ventilation. | Diagnostic Test: Preoperative Parameters<br>* Preoperative Hmg and serum creatinine levels<br>Other: Peroperative Parameters<br>* Scope duration, perforation, hemorrhage, etc. complications<br>Other: Postoperative Parameters<br>* Stone-free rates, complications like postoperative hemorrhage and fever, hospital stay, etc<br>Other: Movement of kidney<br>* Changes in renal stone position during simultaneous normal ventilation and single lung ventilation.<br>Procedure: single lung ventilation<br>* Patients in this group will intubated with an endotracheal tube and then a bronchial blocker will be placed with the help of a fiberoptic bronchoscope or will be intubated with a double lumen endobronchial tube. One lung ventilation will be applied<br>|
| Active Comparator: Patients given standard ventilation<br>This group will have standard ventilation. Preoperative Parameters : Hmg, serum creatinine levels Peroperative Parameters : Scope duration, perforation, hemorrhage, etc. complications) Postoperative parameters (stone-free rates, complications like postoperative hemorrhage and fever, hospital stay, etc) Movement of kidney : Changes in renal stone position during simultaneous normal ventilation and single lung ventilation. | Diagnostic Test: Preoperative Parameters<br>* Preoperative Hmg and serum creatinine levels<br>Other: Peroperative Parameters<br>* Scope duration, perforation, hemorrhage, etc. complications<br>Other: Postoperative Parameters<br>* Stone-free rates, complications like postoperative hemorrhage and fever, hospital stay, etc<br>Other: Movement of kidney<br>* Changes in renal stone position during simultaneous normal ventilation and single lung ventilation.<br>Procedure: standard ventilation<br>* Patients in this group will be intubated with standart single lumen endotracheal tubes and standart two lung ventilation will be applied.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in renal stone position during ventilation | During the operation, the stone may move during deep inspirium and expirium sequences linked to deep ventilation which may lengthen the operation. Preoperative and postoperative Scope will be used to evolve the renal movement. The values will be recorded in milimeters by comparing it. | 1-2 Hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Scope duration | Movement of the kidney during the procedure may cause peroperative complications and lengthen operation and scope durations. | 10-30 Seconds | 
| Total anesthesia duration | Movement of the kidney during the procedure may cause peroperative complications and lengthen operation and scope durations. | 1-2 Hours | 
| Hospital stay | During the operation, the stone may move during deep inspirium and expirium sequences linked to deep ventilation which may lengthen the operation and scope durations and brings risks such as perforation during laser lithotripsy application. It may effect hospital stay duration. | 1-3 Days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
RIRS, Kidney Stone, Single lung ventilation, Simultaneous normal ventilation