Objectives: We present a video of some tricks of percutaneous surgery, developed to decrease operating time and irradiation, in the split-leg modified lateral position. Methods: Since January 2003, percutaneous surgery is performed in the split-leg modified lateral position. The thorax is in the lateral position, the pelvis is in an oblique position, and the lower limbs are split and bent in the lowest position. To facilitate superior calyx puncture, we use a caudal renal displacement technique, by the lever manoeuvre, using an 18-gauge-needle inserted through a lower calyx. When the kidney has a high mobility, the Amplatz dilator and sheath are stopped just outside the renal capsule. The renal parenchyma tunnel is widened using a bi-prong-forceps under endoscopic vision. The nephroscope is used as an aspiration tip to remove small stones fragments. When another percutaneous tract is necessary, after calyceal puncture and dilation to 12 Fr, the rigid ureteroscope mobilizes stones to the renal pelvis. The nephroscope perform fragmentation and extraction via the first tract. Results: PCNL in the flank split leg modified position resulted in decreased operating room time, less manipulation of the anesthetized patient, using only one set of drapes, and allowed simultaneous antegrade and retrograde endoscopic approach to upper urinary tract. Adjunct procedures were TURP or bladder tumors, rigid ureteroscopy, and endopyelotomy. The needle renal displacement technique was usually effective, except when the kidney was fixed with previous open surgery. Dilating the renal parenchyma using blunt dissection with a bi-prong forceps resulted in less time and irradiation in mobile kidneys. The aspiration technique with the nephroscope provides the greatest chances to have a “stone free” status, from even the fine sand debris. Conclusion: PCNL in the flank split leg-modified position have greater versatility of stone manipulation along the entire upper urinary tract. These tricks provided a real benefit, saving money, time and irradiation.