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Determining the angle and depth of puncture for fluoroscopy-guided percutaneous renal access in the prone position.

Sharma G, Sharma A - Indian J Urol (2015 Jan-Mar)

Bottom Line: Optimal renal access is necessary for ensuring a successful and complication-free percutaneous nephrolithotomy.The number of attempts, time of fluoroscopy and difference between estimated and actual depth were noted and analyzed.No complications related to access were observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, and Department of Radiology, Chitale Clinic Pvt. Ltd., 165 D Railway Lines, Solapur, Maharashtra, India.

ABSTRACT

Introduction: Optimal renal access is necessary for ensuring a successful and complication-free percutaneous nephrolithotomy. We describe a technique to determine the angle and depth of puncture for fluoroscopy-guided percutaneous renal access in the prone position.

Materials and methods: Forty-two consecutive patients undergoing percutaneous nephrolithotomy from January 2014 had a fluoroscopy-guided access in the prone position. Using the bull's eye technique, the site of skin puncture and the angle of puncture were determined. These parameters were utilized to calculate, mathematically, the depth of the targeted calyx. These measurements were then utilized for puncture. The actual depth of puncture was then calculated. The number of attempts, time of fluoroscopy and difference between estimated and actual depth were noted and analyzed.

Results and limitations: There was a difference of 0-3 mm between the estimated and the actual depth at which puncture was made. Single-attempt puncture was possible in >95% cases. No complications related to access were observed.

Conclusion: By estimating the angle and depth of puncture, the percutaneous renal access becomes technically less challenging.

No MeSH data available.


The angle of puncture being determined using the protractor held parallel to the operating table and the C arm rotated 30° toward the surgeon
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Figure 2: The angle of puncture being determined using the protractor held parallel to the operating table and the C arm rotated 30° toward the surgeon

Mentions: Under general anesthesia, with the patient prone and the C arm in the anteroposterior position, diluted contrast was instilled via the pre-placed ureteric catheter to opacify the collecting system. With the respiration suspended at end expiration by the anesthesiologist, the desired calyx was selected and the skin site corresponding to the target calyx was marked on the back as point A [Figure 1]. The C arm was then rotated 30° towards the surgeon and the 18G diamond tip needle was held over the targeted calyx to get the bull's eye effect. The site on the skin over the targeted calyx is marked here as point B [Figure 1]. The angle that the needle is making with the patient's back is calculated using a protractor, which is positioned in a way that it is parallel to the operating table [Figure 2].


Determining the angle and depth of puncture for fluoroscopy-guided percutaneous renal access in the prone position.

Sharma G, Sharma A - Indian J Urol (2015 Jan-Mar)

The angle of puncture being determined using the protractor held parallel to the operating table and the C arm rotated 30° toward the surgeon
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300570&req=5

Figure 2: The angle of puncture being determined using the protractor held parallel to the operating table and the C arm rotated 30° toward the surgeon
Mentions: Under general anesthesia, with the patient prone and the C arm in the anteroposterior position, diluted contrast was instilled via the pre-placed ureteric catheter to opacify the collecting system. With the respiration suspended at end expiration by the anesthesiologist, the desired calyx was selected and the skin site corresponding to the target calyx was marked on the back as point A [Figure 1]. The C arm was then rotated 30° towards the surgeon and the 18G diamond tip needle was held over the targeted calyx to get the bull's eye effect. The site on the skin over the targeted calyx is marked here as point B [Figure 1]. The angle that the needle is making with the patient's back is calculated using a protractor, which is positioned in a way that it is parallel to the operating table [Figure 2].

Bottom Line: Optimal renal access is necessary for ensuring a successful and complication-free percutaneous nephrolithotomy.The number of attempts, time of fluoroscopy and difference between estimated and actual depth were noted and analyzed.No complications related to access were observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, and Department of Radiology, Chitale Clinic Pvt. Ltd., 165 D Railway Lines, Solapur, Maharashtra, India.

ABSTRACT

Introduction: Optimal renal access is necessary for ensuring a successful and complication-free percutaneous nephrolithotomy. We describe a technique to determine the angle and depth of puncture for fluoroscopy-guided percutaneous renal access in the prone position.

Materials and methods: Forty-two consecutive patients undergoing percutaneous nephrolithotomy from January 2014 had a fluoroscopy-guided access in the prone position. Using the bull's eye technique, the site of skin puncture and the angle of puncture were determined. These parameters were utilized to calculate, mathematically, the depth of the targeted calyx. These measurements were then utilized for puncture. The actual depth of puncture was then calculated. The number of attempts, time of fluoroscopy and difference between estimated and actual depth were noted and analyzed.

Results and limitations: There was a difference of 0-3 mm between the estimated and the actual depth at which puncture was made. Single-attempt puncture was possible in >95% cases. No complications related to access were observed.

Conclusion: By estimating the angle and depth of puncture, the percutaneous renal access becomes technically less challenging.

No MeSH data available.