Purpose: Retrograde intrarenal surgery (RIRS) has been accepted as a first-line therapeutic option for kidney stones <2 cm. Renal mobility might be a challenging situation for the surgeon targeting the laser, thereby limiting the renal mobility during surgery might affect the surgical success. The main objective of the present trial was to evaluate the effect of two different ventilation modes on the efficacy and safety of RIRS performed under general anesthesia. Materials and Methods: The patients undergoing RIRS from January 2023 to April 2023 were prospectively enrolled in the trial. In the standard ventilation (SV) mode, the tidal volume was 8 to 10 mL/kg with respirations per minute being 10-15, whereas in the high ventilation (HV) mode the tidal volume was reduced to 6 to 8 mL/kg with the frequency being increased to 15 to 18 respirations/minute. For the purposes of the trial and the randomization, the anesthesiologist was informed about the ventilation mode used, whereas the surgeon was blinded. The surgical success rates and the observed complications were compared between SV and HV modes. Results: A total of 144 patients were enrolled with the mean age 48.78 ± 14.16 years. The mean duration of operation was 62.9 ± 26.3 minutes in the SV group, whereas it was 58.4 ± 20.1 minutes in the HV group (p = 0.031). Fragmentation rate of the stones per minute was higher in the HV group with the difference being statistically significant (p = 0.003). In the preoperative period, while hematuria was seen at higher rates in the HV group, the difference was not statistically significant (p = 0.671). Stone-free rates (Grades A-B-C) and the rates of postoperative complications were comparable between the groups (p = 0.605 and p = 0.676, respectively). Conclusion: Using HV mode during the RIRS decreased the operative time and provided the surgeon with the ability to target the laser more effectively. Surgeons might prefer using the HV mode during RIRS in a mobile kidney to reduce their operative time and perform comfortable surgery. ClinicalTrials.gov: The trial is registered at ClinicalTrials.gov with the registration number of NCT05792670.

中文翻译：

---

高通气模式会影响逆行肾内手术的成功率吗？一项单盲、随机、前瞻性、单中心研究。

目的：逆行肾内手术 (RIRS) 已被认为是 <2 cm 肾结石的一线治疗选择。对于瞄准激光的外科医生来说，肾活动度可能是一个具有挑战性的情况，因此在手术期间限制肾活动度可能会影响手术的成功。本试验的主要目的是评估两种不同通气模式对全身麻醉下进行的 RIRS 的有效性和安全性的影响。材料和方法：前瞻性地将2023年1月至2023年4月接受RIRS的患者纳入该试验。在标准通气（SV）模式下，潮气量为 8 至 10 mL/kg，每分钟呼吸次数为 10-15 次；而在高通气（HV）模式下，潮气量降至 6 至 8 mL/kg，每分钟呼吸次数为 10-15 次。频率增加至15至18次呼吸/分钟。为了试验和随机化的目的，麻醉师被告知所使用的通气模式，而外科医生则被蒙蔽。比较 SV 和 HV 模式的手术成功率和观察到的并发症。结果：共有144名患者入组，平均年龄48.78±14.16岁。SV 组的平均手术时间为 62.9 ± 26.3 分钟，而 HV 组的平均手术时间为 58.4 ± 20.1 分钟 (p = 0.031)。HV 组每分钟的结石破碎率较高，差异具有统计学意义 (p = 0.003)。术前，虽然 HV 组血尿发生率较高，但差异无统计学意义 (p = 0.671)。各组之间的无结石率（ABC 级）和术后并发症发生率相当（分别为 p = 0.605 和 p = 0.676）。结论：在 RIRS 期间使用 HV 模式减少了手术时间，并使外科医生能够更有效地瞄准激光。外科医生可能更喜欢在移动肾脏中进行 RIRS 期间使用 HV 模式，以减少手术时间并进行舒适的手术。ClinicalTrials.gov：该试验已在 ClinicalTrials.gov 注册，注册号为 NCT05792670。