Endoscopic Combined Intrarenal Surgery (ECIRS)

Endoscopic Combined Intrarenal Surgery (ECIRS) is a highly advanced minimally invasive surgery offered at the MASSH Super Speciality Hospital in South Delhi. It is used to remove all kidney stones from the patient’s body using a combination of two surgeries performed simultaneously. The two surgeries used to perform ECIRS are a Retrograde Intrarenal Surgery (RIRS) and a Percutaneous Nephrolithotomy (PCNL). This surgery is highly effective for the treatment of large and hard-to-reach kidney stones. It reduces the number of incisions made into the body and uses the benefits of both surgeries to improve surgical outcomes and expedite recovery.

How Is ECIRS Performed at MASSH Super Speciality Hospital?

The ECIRS procedure requires patients to be under general anaesthesia for a comfortable and safe surgical experience. Here’s a detailed overview of how the procedure is performed, categorised into pre-procedure preparation, procedure, and post-surgical care.

Pre-Surgical Preparation

• The first step of the surgical preparation begins with performing a thorough check-up of the patient’s vitals. This includes heart rate, blood pressure, and other health markers.
• If the vitals are up to standard, the patient is transported to the operating theatre, where the surgery begins with anaesthesia.

ECIRS Surgical Procedure

• Once the patient is sedated, the surgery begins with the RIRS procedure, since it is minimally invasive. 
• A thin and flexible surgical device known as a ureteroscope is inserted into the urethra of the patient and sent up the urinary tract into the kidneys. 
• The ureteroscope has a high-definition camera attached to its head, which allows surgeons to visualise the surgery site clearly without the need for incisions. 
• At the MASSH Super Speciality Hospital, the ECIRS surgery is performed with specialised 3D visualisation that allows depth perception during surgery. This helps minimise bleeding during surgery and even helps reduce surrounding tissue damage, aiding faster recovery.
• The ureteroscope also comes with a laser attached to it, which is used to fragment the kidney stones once they’re precisely located in the urinary tract. The laser technology employed (Holmium laser) is extremely precise and allows for safe fragmentation of large kidney stones. 
• This is how the RIRS part of the ECIRS surgery is conducted; the PCNL part is also performed simultaneously. 
• Two experienced surgeons at the MASSH Super Speciality Hospital perform these surgeries together in accordance with one another for complete kidney stone removal.
• The PCNL procedure starts with a small incision made strategically into the flank area of the patient’s back. This incision position is strategic because it allows the patient to remain lying on their back during the surgery process. 
• This position aids easy access to the urinary tract for the RIRS part of the ECIRS procedure. 
• As a minimally invasive surgery, an incision of only 1 to 2 cm is made into the patient’s body. 
• The flank incision also allows easy access directly to the patient’s kidneys, without affecting surrounding organs or tissues. 
• Once the incision is made, a nephrostomy tract is inserted into the kidney. 
• The nephrostomy tract is a hollow tube that is used to safely insert surgical tools inside the kidneys.
• Like the ureteroscope, a nephroscope is inserted into the nephrostomy tract. The nephroscope has a camera and a light source attached to it, and it allows surgeons to get real-time visualisation inside the patient’s kidneys. 
• Once the kidney stones are located, the nephrostomy tract is used to insert surgical tools inside the kidneys. 
• These tools are used to either fragment the stones, suction the stones out of the kidneys, or remove them manually using surgical tools. 
• In the case of ECIRS surgery, the RIRS procedure is used to fragment the stone, while the PCNL procedure is used to remove the stones directly from the kidneys.

Post-Surgical Care

• The surgery concludes once the kidney stones are removed or flushed out of the system.
• The ureteroscope is removed from the patient’s body, as is the nephroscope. The PCNL incision is stiched and the patient is slowly taken off from anaesthesia.
• The patient is transported to the recovery area, and this concludes the entire ECIRS surgical process.

ECIRS Recovery at MASSH Super Specialty Hospital

Patients undergoing ECIRS at the MASSH Super Specialty Hospital receive full recovery support from our caregivers. Right after the surgery concludes, patients are transported to a recovery room where they’re kept under observation for a few hours while the effects of anaesthesia wear off. Patients are monitored closely during this time, including a close watch of their vitals to ensure the patients are recovering safely.

After the initial recovery, some patients are discharged if their recovery is adequate as per the surgeons and medical team. In some cases, patients may be required to stay overnight at the hospital and be discharged the following day of the procedure. Before discharge, patients are provided with thorough post-surgical care instructions to ensure they can keep themselves safe and recover well at home. Follow-up visits are recommended for patients in order to keep a close track of their recovery and to prevent the risk of kidney stone recurrence.

Advantages of ECIRS For Patients

• Lower Surgery Time: Due to a two-pronged approach, ECIRS allows surgeons to reduce surgery time significantly as two surgeons work simultaneously.
• Complex Stone Removal: ECIRS is effective for complex kidney stone removal. This includes large stones or stones lodged in hard-to-reach areas of the urinary tract.
• Minimally Invasive: ECIRS only requires one incision for the surgery, which causes minimal tissue damage and reduces the surgical risks for patients.
• Faster Recovery: The smaller incision and limited tissue damage help improve recovery time, allowing patients to get back to their lifestyle sooner.
• Maximum Stone Removal: As a two-way surgery, ECIRS allows surgeons to remove the maximum number of kidney stones in one procedure.