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Updated: May 14, 2026
03:56
A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
[The Endovision technique in renal percutaneous lithotripsy]
Simona Serra1, Andrea Corona, Giacomo Caddeo
1Urologic Clinic, University of Cagliari-Cagliari - Italy.
Urologia
|February 2, 2013
Summary
Combining eco-fluoro-guided puncture with flexible ureteroscopy offers a safer kidney access method. However, challenges exist in identifying optimal puncture sites and maintaining visibility, potentially requiring conventional completion.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrology
Background:
- Percutaneous kidney access aims for enhanced safety.
- Combining ultrasound-fluoroscopy guidance with flexible ureteroscopy offers an alternative approach.
- Standardizing this combined technique and evaluating its benefits and drawbacks is crucial.
Purpose of the Study:
- To standardize a combined eco-fluoro-guided puncture and flexible ureteroscopy technique for percutaneous kidney access.
- To evaluate the advantages and limitations of this integrated approach in patients with pyelic or pyelocaliceal stones.
Main Methods:
- 26 patients with kidney stones underwent flexible ureterorenoscopy as the initial percutaneous access.
- The procedure involved pre-puncture caliceal topography assessment and selection of a suitable calyx.
- Eco-fluoro-guided puncture was performed while maintaining endoscopic vision, followed by access dilation.
Main Results:
- Optimal puncture orientation was achieved in 16 cases using the lower caliceal group and in 10 using the middle caliceal group.
- Puncture correction was necessary in 16 cases due to fornix penetration or incorrect calyx entry.
- Bleeding required repeat procedures in 10 cases, and 6 cases were completed conventionally due to technical difficulties.
Conclusions:
- Identifying a suitable lower calyx for puncture is not consistently possible.
- The technique involves inherent limitations in visibility and potential kidney displacement.
- While feasible in prone and supine positions, the procedure's completion is not guaranteed.
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