Although percutaneous nephrological surgery is a minimally invasive procedure, there are many risks that we should have enough awareness of. I. Intraoperative bleeding Intraoperative bleeding is the most common and very dangerous complication. The kidney is an organ with rich blood circulation and fragile texture. The blood vessels of the kidney are subdivided into segments, and the renal artery is divided into two groups, anterior and posterior, with a non-vascular area in the middle called Brodel’s line, and the anterior group is pointed, upper, middle and lower, as shown in the figure: Prevention and treatment methods of surgical bleeding (1) Make good preoperative preparations: prepare blood adequately, and make it a contraindication to surgery for patients with anemia and abnormal blood clotting function. (2) Minimize the number of punctures and try to choose the puncture site on the dorsal side of the kidney. (3) Minimize the duration of the operation: if necessary, the stone can be removed in separate operations. (4) Temporary postoperative clamping of the nephrostomy tube for 2h: it can achieve hemostasis for venous bleeding. (5) Try not to swing the mirror substantially during the operation, as this can tear the renal parenchyma and cause bleeding. (6) Pay attention to the patient’s vital signs and the amount of bleeding at any time during the operation: if necessary, the operation should be terminated in time and the stone should be removed by second-stage surgical lithotripsy. Intraoperatively, the decision to terminate the operation should be based on the patient’s vital signs and bleeding. Usually, if the bleeding is venous or renal parenchymal laceration, the bleeding can be stopped by clamping the nephrostomy tube after termination of surgery; if the bleeding is arterial or large vessel bleeding, interventional super-selective renal vascular embolization should be performed decisively. Renal pelvis lacerations can occur during the puncture process to establish surgical access and during lithotripsy. As long as the postoperative nephrostomy tube is kept open, the renal pelvis injury can heal on its own. Injury to surrounding tissues and organs During percutaneous nephrolithotomy, either during puncture or lithotripsy, there is a risk of injury to surrounding organs, such as the pleura, peritoneum, and intestinal canal. Therefore, in the process of establishing the operating channel for renal puncture, we should not only pay attention to the direction of puncture, but also keep in mind the control of the depth of puncture – it is better to be shallow than deep, and make accurate judgment of any situation that may arise at any time during the operation. As seen in the figure, the organs surrounding the kidney: on the left side, the spleen is above the outside of the kidney, the descending colon is below the outside, the stomach is inside the front, and the tail of the pancreas is in front of the kidney tip. On the right side, outside of the kidney is the liver, anteriorly inside is the descending duodenum, and anteriorly below outside is the ascending colon, while posteriorly to the bilateral kidneys, there are fewer organs and the suprarenal pole has the diaphragm immediately attached to it. All these organs are at risk of injury. IV. Stone residual Especially for cast stones and multiple stones, the chance of stone residual is higher. It can be treated with postoperative extracorporeal shock wave lithotripsy, which can mostly remove the residual stones.