Performing easy prone punction

Percutaneous renal surgery has been considered one of the most important advances in urology. There are several possibilities to perform a kidney puncture such as using fluoroscopy, ultrasound or both. The aim of this article is to describe our puncture technique.

Correct puncture is one of the most critical and challenging steps during percutaneous surgery. Bull's eye technique and other similar techniques supported by fluoroscopy try to make triangulations and provide different views. On the other hand, many urologists prefer the usage of ultrasound to help reach the calyx. The perfect puncture could also be a scanner guided puncture.

Under general anesthesia, cystoscopy is performed for ureteral catheter placement. The excretory system is opacified by administering contrast to the ureteral catheter. Perpendicular puncture on the selected calyx is done; this is a 90° puncture with a fine spinal needle 20G into the selected calyx under fluoroscopy control to visualize the correct penetration into the calyx. Moving forward to the next step, an 18G needle is used to follow the correct calyx - infundibulum - renal pelvis path. The goal is to put together both tips of the 2 needles (needle Kiss technique).

After several years of performing percutaneous surgery, we conclude that our technique can facilitate the prone position puncture thanks to the information given from the thin needle while simultaneously minimizing the use of fluoroscopy for triangulation maneuvers and avoiding the use of ultrasound to determine the depth of the target calyx.