PCNL: understanding the beauty of the supine position

Cent European J Urol. 2017; 70: 68 doi: 10.5173/ceju.2017.1316 Having received the opportunity to add my comments to this outstanding editorial represents for me a great honour and pleasure for two reasons. First, Dr. Giusti is a prominent figure in endourology and an enthusiastic teacher of supine PCNL, therefore forming an ideal academic partnership with Dr. Proietti in propagating this procedure around the world has been a truly outstanding experience. Secondly, Dr. Giusti served as my mentor in implementing supine PCNL. I could even say that I fell in love with this procedure at first sight. It has not only been the curiosity, but has been the challenge of implementing a new approach. I have performed almost one thousand prone PCNLs and have had to combat with several issues such as: long hours of bending over while in a standing position over the patient, while bearing the weight of a lead apron on my shoulders, changing the patient’s position during the operation, arguing with the anaesthesiologist about access to the patient’s airway and monitoring devices, performing additional percutaneous accesses in certain cases and puncturing supracostally with the subsequent inevitable pleural complications in order to treat staghorn stones. I have understood that it can be done differently, and that Valdivia et al. [1]. solved those problems in an ingenious way. Once I had performed my Mario Sofer