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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 distance between point A to point B1 is equal to the distance between point A and point B
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Figure 3: The distance between point A to point B1 is equal to the distance between point A and point B

Mentions: The same principle can be applied in the triangulation technique. The C arm is brought to its anteroposterior position. The line of puncture is determined in alignment with the infundibulum from point A. On this line, the point B1 is marked. The distance between A to B1 is equal to the distance between A to B [Figure 3]. From the point B1, access can be obtained using the triangulation technique. The angle of puncture is as determined by the protractor earlier using the bull's eye principle. The depth of puncture is the same as calculated earlier. As the angle of entry is known and the depth is pre-calculated, the needle is advanced with the C arm in the anteroposterior position only (without the need to take it in the oblique position) and the target calyx is punctured. Aspiration of clear fluid confirms a successful puncture. Then, the length of the needle outside the skin is measured and is subtracted from the actual length of the needle to calculate the actual depth at which the puncture was made.


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 distance between point A to point B1 is equal to the distance between point A and point B
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: The distance between point A to point B1 is equal to the distance between point A and point B
Mentions: The same principle can be applied in the triangulation technique. The C arm is brought to its anteroposterior position. The line of puncture is determined in alignment with the infundibulum from point A. On this line, the point B1 is marked. The distance between A to B1 is equal to the distance between A to B [Figure 3]. From the point B1, access can be obtained using the triangulation technique. The angle of puncture is as determined by the protractor earlier using the bull's eye principle. The depth of puncture is the same as calculated earlier. As the angle of entry is known and the depth is pre-calculated, the needle is advanced with the C arm in the anteroposterior position only (without the need to take it in the oblique position) and the target calyx is punctured. Aspiration of clear fluid confirms a successful puncture. Then, the length of the needle outside the skin is measured and is subtracted from the actual length of the needle to calculate the actual depth at which the puncture was made.

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.