Thoracoscopy-assisted high intercostal percutaneous renal access

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard procedure for kidney stone removal.
• Accessing the upper pole calix can be challenging and carries risks.
• Alternative access routes are needed to improve safety and efficacy.

Purpose of the Study:

• To describe a novel technique for safely accessing the upper pole calix.
• To evaluate the safety and efficacy of 9th or 10th intercostal puncture for PCNL.
• To utilize thoracoscopy to enhance safety during renal access.

Main Methods:

• A 9th or 10th intercostal approach was employed for PCNL in nine patients.
• Thoracoscopy via the 5th or 6th intercostal space was used to guide nephrostomy needle placement.
• Standard PCNL procedures were performed after successful access.

Main Results:

• Successful renal access was achieved in all nine patients.
• No visceral injuries were reported.
• Seven patients were rendered stone-free after the initial PCNL procedure; two required additional therapy.
• Chest tubes were used in eight patients and removed on postoperative day three without impacting hospital stay.

Conclusions:

• Access through the 9th or 10th intercostal space is a viable option for specific PCNL cases.
• Thoracoscopy-assisted percutaneous renal access provides direct visualization, significantly reducing the risk of pulmonary injury.
• This technique offers a safe and effective method for challenging upper pole calix access.