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Thoracoscopy-assisted high intercostal percutaneous renal access.
1Division of Urology, St. Michael's Hospital, University of Toronto, ON, Canada.
Journal of Endourology
|September 13, 2001
Summary
This study presents a safe method for accessing the upper pole calix using a 9th or 10th intercostal puncture for percutaneous nephrolithotomy (PCNL). Thoracoscopy ensures safe needle passage, preventing lung injury during kidney stone removal.
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.