Comparison of Different Ventilation Modes for Reducing Kidney Motion During Retrograde Intrarenal Surgery (RIRS-VENT)

Comparison of Different Ventilation Modes for Reducing Kidney Motion During Retrograde Intrarenal Surgery: A Prospective Randomized Controlled Trial

This randomized clinical trial will compare four ventilation strategies during retrograde intrarenal surgery performed under general anesthesia. The study aims to determine whether reducing respiratory-related kidney movement improves surgical success and decreases perioperative complications. Eighty adult patients will be randomly assigned to standard ventilation, hypoventilation, intermittent apnea ventilation, or one-lung ventilation. Surgical outcomes and perioperative complications will be compared between groups.

Study Overview

• Status: Not yet recruiting
• Conditions: Nephrolithiasis; Kidney Stones
• Intervention / Treatment: Procedure: Standard Ventilation; Procedure: Hypoventilation; Procedure: Intermittent Apnea Ventilation; Procedure: One-Lung Ventilation

Detailed Description

Retrograde intrarenal surgery is commonly performed under general anesthesia, but respiratory movement may interfere with kidney stability during the procedure. This prospective, randomized, single-center trial will compare standard ventilation, hypoventilation, intermittent apnea ventilation, and one-lung ventilation in adult patients undergoing retrograde intrarenal surgery. The primary objective is to determine whether different ventilation strategies improve surgical success by reducing kidney movement. Secondary outcomes include operative time, stone access time, fluoroscopy time, laser use time, complications, length of hospital stay, and postoperative stone-free rate.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tuna Ertürk, MD; Phone Number: +905325010066; Email: tunaerturk22@yahoo.com
• Study Contact Backup: Name: Hakan Emirkadı, MD; Phone Number: +905322609367; Email: suheylaatay81@gmail.com

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye), 34668
      • Sultan Abdulhamid Han Training and Research Hospital
      • Contact: Tuna Ertürk, MD; Phone Number: +905325010066; Email: tunaerturk22@yahoo.com
      • Contact: Hakan Emirkadı, MD; Phone Number: 05322609367; Email: hemirkadi@gmail.com
      • Principal Investigator: Tuna Ertürk, MD
      • Sub-Investigator: Hakan Emirkadı, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Age 18-75 years. ASA physical status I-III. Scheduled for elective RIRS/RIRC under general anesthesia. No obstructive or restrictive pulmonary disease. No history of pneumothorax. No pulmonary mass or other significant respiratory disease. Normal coagulation parameters and not receiving antithrombotic therapy. No active urinary tract infection. Written informed consent.

Exclusion Criteria:

Age <18 or >75 years. ASA IV. Obstructive or restrictive pulmonary disease. History of pneumothorax. Pulmonary mass or significant respiratory disease. Receiving antithrombotic therapy or abnormal coagulation. Active urinary tract infection or urinary tract anatomical abnormality. Refusal or inability to provide informed consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard Ventilation; Patients will receive standard volume-controlled mechanical ventilation during retrograde intrarenal surgery under general anesthesia.	Procedure: Standard Ventilation; Volume-controlled mechanical ventilation using standard ventilator settings during general anesthesia.
Experimental: Hypoventilation; Patients will receive hypoventilation with reduced tidal volume and respiratory rate during retrograde intrarenal surgery under general anesthesia.	Procedure: Hypoventilation; Volume-controlled mechanical ventilation using reduced tidal volume and respiratory rate during general anesthesia.
Experimental: Intermittent Apnea Ventilation; Patients will receive intermittent apnea periods during selected surgical steps, in coordination with the surgeon.	Procedure: Intermittent Apnea Ventilation; Intermittent apnea periods applied during selected stages of retrograde intrarenal surgery to reduce kidney motion.
Experimental: One-Lung Ventilation; Patients will receive one-lung ventilation during selected surgical steps, in coordination with the surgeon.	Procedure: One-Lung Ventilation; One-lung ventilation applied during selected stages of retrograde intrarenal surgery to reduce kidney motion.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kidney Motion During Retrograde Intrarenal Surgery	Kidney motion during surgery will be evaluated and compared among the four ventilation strategies.	During surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stone-free Rate	Percentage of patients who are stone-free after retrograde intrarenal surgery.	Postoperative Day 30
Operative Time	Total duration of surgery measured from the beginning to the end of the surgical procedure.	During surgery
Fluoroscopy Time	Total fluoroscopy exposure time recorded during the procedure.	During surgery
Laser Activation Time	Total duration of laser use during stone fragmentation.	During surgery
Perioperative Complications	Occurrence of intraoperative and postoperative complications.	Periprocedural
Length of Hospital Stay	Number of days of hospitalization.	Periprocedural

Collaborators and Investigators

• Sponsor: Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
• Investigators: Principal Investigator: Tuna Ertürk, MD, University of Health Sciences Sultan 2. Abdulhamid Han Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): July 15, 2026
• Primary Completion (Estimated): November 15, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: July 5, 2026
• First Submitted That Met QC Criteria: July 10, 2026
• First Posted (Actual): July 15, 2026

Study Record Updates

• Last Update Posted (Actual): July 15, 2026
• Last Update Submitted That Met QC Criteria: July 10, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: General Anesthesia; RIRS; Retrograde Intrarenal Surgery; Mechanical Ventilatio; Kidney Motion
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Calculi; Pathological Conditions, Anatomical; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urolithiasis; Urinary Calculi; Pathological Conditions, Signs and Symptoms; Kidney Calculi; Nephrolithiasis; Therapeutics; Airway Management; Respiration, Artificial; One-Lung Ventilation
• Other Study ID Numbers: 21-64

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be made publicly available to protect participant confidentiality.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No