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Figure 1a Galdakao-modified Valdivia position: For the resolution of complex endourological procedures we have gradually adopted this new position, allowing simultaneous percutaneous and retrograde access. The supine Valdivia position is the same, but the leg of the operated side is extended, while the contralateral one is well abducted. The patient lies supine with a 3-L saline bag under the flank, filled with air and clamped with forceps, allowing volume control by adding or subtracting air with a syringe, to find the best position. Alternatively, two distinct 'gel' pillows define an interposed operative space on the flank, allowing the use of instruments with lower entry of the light cable. Care is taken to prevent pressure injuries by using stirrups with padding for the upper and lower extremities.
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Ibarluzea, G.1
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