Percutaneous nephrolithotomy is a preferred and proven surgical method for the treatment of large kidney stones. Although it has been used less frequently in recent years due to advances in flexible ureteroscopy and laser systems, it remains the first choice for renal calculi above 2 cm in current guidelines. Proper access is essential for successful percutaneous kidney stone surgery. Furthermore, having the right indication for surgery and high-quality preoperative imaging are the most important requirements for avoiding complications and high success. The most commonly used method for percutaneous surgery to the kidney is retrograde pyelography and fluoroscopy-guided access. Depending on the surgeon’s preference and experience, monoplanar, biplanar or triangulation methods may be used. Another important instrument used for access is ultrasound. Percutaneous access under ultrasound guidance is quite successful in experienced hands. In addition, another important advantage of using ultrasound is that it reduces the use of radiation. In recent years, the simultaneous use of percutaneous and flexible ureteroscopy for complex stones has increased. In this case, endoscopy-assisted access has also become popular as a method that reduces the risk of bleeding and increases the chance of successful access. In cases of renal anomalies (e.g. pelvic kidney), retrorenal colon or organomegaly, CT/MR-guided access or laparoscopy-assisted access may be preferred. Apart from conventional methods, navigation-assisted and robot-assisted access have also been described. However, these methods are still in the experimental stage and have not been used routinely.