Ultrasound guided dual tract supine PCNL with simultaneous use of two different energy sources by two urologists working in unison-an innovative approach in staghorn calculus

Complete staghorn renal calculi are surgical challenge requiring multi-tract or staged PCNL. We report a case of supine PCNL where complete stone clearance was achieved with dual tracts (24 Fr/lower pole and 16Fr/upper pole) through which two surgeons operated simultaneously using two different energy sources (pneumatic/ultrasound lithotripter through 24Fr and Thulium Fiber laser through 16Fr). Strong water currents generated by dual-tract irrigation augmented the mini-PCNL venturi effect facilitating stone fragment evacuation. This is first reported case of two surgeons operating simultaneously using two different energy sources, in supine position in a limited space on a complete staghorn stone.