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Related Experiment Videos

Percutaneous nephrolithotomy through an intercostal approach.

D L Narasimham1, B Jacobsson, P Vijayan

  • 1Department of Diagnostic Radiology, Hamad General Hospital, Qatar, The Arabian Gulf.

Acta Radiologica (Stockholm, Sweden : 1987)
|March 1, 1991
PubMed
Summary
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Percutaneous nephrolithotripsy via the 11th intercostal space is safe for lower/middle calyx stones. Upper pole or higher approaches increase thoracic complication risk, but can be mitigated with specific techniques.

Area of Science:

  • Urology
  • Thoracic Surgery
  • Medical Imaging

Background:

  • Percutaneous nephrolithotripsy (PCNL) is a common procedure for kidney stone removal.
  • Intercostal approaches to PCNL, while effective, carry potential risks of thoracic complications.
  • Optimizing safety requires careful consideration of the entry point and procedural techniques.

Observation:

  • A 5-year review of 56 intercostal PCNL procedures revealed varying complication rates based on tract location.
  • The 11th intercostal space approach into lower or middle calyces had minimal complications (3/53 patients).
  • The 10th intercostal space approach into upper calyces, especially with improper sheath/catheter use, led to significant hydro/pneumothorax (2/3 patients).

Findings:

  • PCNL via the 11th intercostal space into lower or middle calyces is associated with a low risk of thoracic complications.

Related Experiment Videos

  • Approaches utilizing the 10th intercostal space or targeting upper calyces increase the risk of significant thoracic injury.
  • Proper patient selection, fluoroscopic guidance to identify lung borders, general anesthesia with breath-holding, and specific device usage are crucial for safety.

    • Implications:

    • The 11th intercostal space is the preferred intercostal entry for PCNL, particularly for lower and middle calyx access.
    • Minimizing thoracic complications involves meticulous technique, including precise puncture site identification and appropriate use of working sheaths and drainage catheters.
    • These findings support refining PCNL protocols to enhance patient safety during intercostal access procedures.