Combined Direct Visual and Imaging Guided Percutaneous Nephrolithotomy: A Novel Technique
Introduction Percutaneous nephrolithotomy (PCNL) is a common urological procedure. Obtaining secure percutaneous access to the collecting system which is usually done under fluoroscopic guidance and tract dilatation is a crucial step toward a successful and safe procedure. This study aims to introd...
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| Autores principales: | , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Urology Research Center
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/d6e749c7ee014791bae5c40ee34b8c53 |
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| Sumario: | Introduction
Percutaneous nephrolithotomy (PCNL) is a common urological procedure. Obtaining secure percutaneous access to the collecting system which is usually done under fluoroscopic guidance and tract dilatation is a crucial step toward a successful and safe procedure. This study aims to introduce a novel technique to modify this procedure.
Method
Combined Direct Visual and Imaging Guided PCNL is performed by using specific 28 Fr dilatators with a customized central lumen that accepts a 4.5 F semi-rigid ureteroscope to visually confirm the puncture of target calyx and passing a guidewire. This instrument was passed as a one-shot dilator after the withdrawal of the puncture needle. The rest of the procedure was then carried out in a standard manner. This novel technique was introduced in 12 patients in 2020 in Sina hospital, after completing the informed consent.
Results
The mean age was 53.58±11.96 and the average stone size was 4.1±0.58 cm and the average time from insertion of the needle into target calyx until securing a guide-wire inside the collecting system (pelvis, ureter) was 95 seconds (84-107). Fluoroscopy time (total time required to obtain the access but not the whole operation) was averagely 30.25±8.01 seconds. There were no intraoperative or postoperative complications as a result of this technique.
Conclusions
Use of the ureteroscope loaded with the dilator and sheath during PNCL seems to be a feasible and safe technique for dilatation of access tract during one shot PCNL. |
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