Determining Site of Skin Puncture for Percutaneous Renal Access Using Fluoroscopy-Guided Triangulation Technique

Sharma, Gyanendra; Sharma, Anshu

doi:10.1089/end.2008.0170

Cited by 26 publications

(15 citation statements)

References 3 publications

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“…Using this technique, the efficient use of rigid instruments is promoted, and excessive torque that may lead to parenchymal trauma and bleeding is decreased. 40 Transfusion rates, however, were not significantly different in the two groups (5% , 5%). The overall success and complication rates were also similar in the two groups.…”

Section: Discussionmentioning

confidence: 80%

Impact of Percutaneous Renal Access Technique on Outcomes of Percutaneous Nephrolithotomy

Tepeler

Armağan

Akman

et al. 2012

Journal of Endourology

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Section: Discussionmentioning

confidence: 80%

Impact of Percutaneous Renal Access Technique on Outcomes of Percutaneous Nephrolithotomy

Tepeler

Armağan

Akman

et al. 2012

Journal of Endourology

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“…Determining the correct point of skin puncture is important in the triangulation technique because a skin puncture that is too medial or lateral to the desired optimum point of entry would result in a tract of variable length and angle of entry in the calyx. [ 4 ] This would interfere with proper access and would hamper the efficient use of the rigid nephroscope. If the angle of entry is not optimum, then it would cause excessive torque on the parenchyma during maneuvering of the nephroscope in the pelvicalyceal system.…”

Section: Discussionmentioning

confidence: 99%

“…If the angle of entry is not optimum, then it would cause excessive torque on the parenchyma during maneuvering of the nephroscope in the pelvicalyceal system. [ 2 4 ] Sharma et al . have described the technique of determining the site of skin puncture, which is a hybrid of the bull's eye and triangulation techniques.…”

Section: Discussionmentioning

confidence: 99%

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

Sharma¹,

Sharma²

2015

Indian J Urol

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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.

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“…(5,6,7,8) Skin entry point was lateral border of erector spinae muscle, at the level of posterior axillary line, puncture is done during expiration for supra coastal access. (8,9,10) Needle position was assessed both in zero and 30 0 angles under fluoroscopy. (11,12,13) After confirmation of needle position within the PCS, and stylet was removed to look for urine gush.…”

Section: Methodsmentioning

confidence: 99%

PCNL - Evaluation of Supra Costal Punctures

Ravichandar¹,

Jagadeeshwar²,

Bhagavan³

et al. 2015

jemds

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To study the effective stone clearance rate, to analyze and study the intra and post-operative complications and the morbidity in terms of hospital stay. MATERIALS AND METHODS: The present study has been conducted in the Department of Urology, Gandhi Hospital, and Hyderabad from November 2012 to December 2014. RESULTS: Total 42 cases were included in supracostal group, in which mid calyceal puncture done in 5 (11.9%) cases, upper calyceal puncture done in 37(88.1%) cases. Post-operative x-ray chest on day one normal in 39(92.85%) cases and 3(7.15%) cases developed hydrothorax, post-operative pain assessment: visual analogue score on average-6.5, post-operative x-ray KUB on day two showed insignificant calculi in 2(4.76%) cases and significant calculi in 3(7.1%) cases. Ancillary procedure: needed for 3(7.1%) cases with significant calculi, one case (2.4%) required relook PCNL and for two cases (4.7%) ESWL was done and blood transfusion required for 3 cases (7.1%). Finally stone clearance rate was 88.9%. CONCLUSIONS: Supracostal PCNL is a safe procedure with acceptable morbidity. When the puncture site is well planned, keeping it on or lateral to posterior axillary line and performed during expiration, would minimize thoracic complications. Supra costal PCNL has high rate of stone clearance (more than 90%) especially when the stone is complex, burden is in upper pole and stone is of stag horn type. The need for ancillary procedures for complete stone clearance is less. The requirement of multiple tracts and their attendant complications are less with supracostal PCNL. It can be done safely in pediatric as well as elderly population.

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Determining Site of Skin Puncture for Percutaneous Renal Access Using Fluoroscopy-Guided Triangulation Technique

Abstract: This technique helps to determine the correct site of skin puncture in the fluoroscopy-guided triangulation technique. It leads to a tract that is of optimum length, proper direction, and is in alignment with the infundibulum.

Cited by 26 publications

References 3 publications

Impact of Percutaneous Renal Access Technique on Outcomes of Percutaneous Nephrolithotomy

Impact of Percutaneous Renal Access Technique on Outcomes of Percutaneous Nephrolithotomy

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

PCNL - Evaluation of Supra Costal Punctures

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