Simplified biplanar (0–90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve

Manzo, Braulio Omar; Torres, José E.; Cabrera, Jose David; Lozada, Edgard; Emiliani, Esteban; Sepúlveda, Fábio; Morales, Christian; Morales, I; Sánchez, H.

doi:10.1007/s00345-021-03669-7

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…Moreover, not only the mean puncture time in the biplanar group is lower than that in the monoplanar group, but also it decreased with time and the number of cases reached its lower value and became stable in a plateau curve after 24 cases. B. Manzo et al 2021 stated that the biplanar (0–90°) puncture technique is easy to learn as ten cases are sufficient to reach the plateau [ 2 ]. while in group A the learning curve still not reached the plateau even with 34 case this was in agree with Negrete-Pulido et al 2010 who stated that 50 cases were needed to reach the learning curve plateau.…”

Section: Discussionmentioning

confidence: 99%

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Simplified biplanar (0–90°) versus monoplanar renal puncture technique in flank free modified supine percutaneous nephrolithotomy regarding outcomes and learning curve: Randomized clinical trial

Elderey,

Ali,

Bendary

et al. 2024

Arab Journal of Urology

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Objective To evaluate the learning curve and the success rate of the biplanar (0–90°) puncture technique in the flank-free modified supine position in comparison to the monoplanar puncture technique. Methods Randomized controlled study included 68 patients more than 18 years with renal stones more than 2 cm from August 2021 to August 2022 were randomly classified by closed envelope method into group A (34 patients) scheduled for monoplanar renal puncture technique in flank-free modified supine PCN. Meanwhile, group B (34 patients) was scheduled for the 0–90° simplified fluoroscopic puncture technique. Morbid obese patients and patients with contraindications for PNL were omitted from the study. Results There was no significant difference between both groups regarding stone distribution and patients’ demographic data. There was a significant difference between both groups regarding puncture attempts. In 88.2% of patients in group B (Biplanar group), the success of renal puncture occurred from the 1st puncture attempt while in 11.2% of patients in group A (monoplanar group). There was a statistically significant difference between both groups in fluoroscopy time and total operation time (p-value <0.001 & p-value: 0.001), respectively. The stone-free rate was 85.2% vs. 88.2% in both groups, respectively, without significant difference. In this study puncture, attempt trials and puncture time were used as indicators for the easiness and rapid educability of the biplanar (0–90°) fluoroscopic guided renal puncture technique. In the biplanar (0–90°) group after 24 cases, the learning curve had reached the plateau. Conclusion Biplanar (0–90°) puncture technique in flank-free modified supine position allows an easy puncture technique with an easy learning curve without affecting the success rate or complication rate.

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Section: Discussionmentioning

confidence: 99%

“…lower calyx stones. The main profession of urologists was surgical competence in PNL being mainly in renal access puncture [ 2 ]. There are many ways to do renal puncture like fluoroscopy, ultrasound, and computed tomography (CT) guidance.…”

Section: Introductionmentioning

confidence: 99%

Simplified biplanar (0–90°) versus monoplanar renal puncture technique in flank free modified supine percutaneous nephrolithotomy regarding outcomes and learning curve: Randomized clinical trial

Elderey,

Ali,

Bendary

et al. 2024

Arab Journal of Urology

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Modified biplanar (0-90o) endoscopic-guided puncture technique for percutaneous nephrolithtomy: refinement with endoscopic combined intrarrenal surgery to reduce fluoroscopy and operative time

Marchini,

Lima,

Campos

et al. 2023

Int. braz j urol.

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Introduction: We aim to publish our innovative modified biplanar 0-90 endoscopic guided puncture technique for percutaneous nephrolithotomy in supine recorded with a GoPro ® camera for standardization of the technique. It solves drawbacks of the fluoroscopic technique, i.e., in kidneys with complex anatomy, it may be challenging to distinguish calyces as they are often superposed, and it does not allow for all benefits of a combined endoscopic approach ( 1 , 2 ). Our technique shortens puncture and fluoroscopic time and is easy to teach and reproduce. Methods: A 77-year-old female patient had previous double J insertion due to an obstructing stone in the right distal ureter. She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care ( 3 , 4 ) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen. The tip of the flexible scope was used to mark point A with the C-arm in the 0-degree position and line B in the 90-degree position. Puncture was fast and the MiniECIRS was uneventful with a single mid-pole access guided by the flexible scope. The surgeon had a Full-HD GoPro ® camera mounted on his head, controlled by the surgical staff. All essential surgical steps were recorded. Results: The quality of the recorded movie was graded as excellent, and the camera did not cause any discomfort to the surgeon. Operative and X-Ray time were 120minutes and 2minutes (7.64mGy). Hemoglobin drop was 0.8g/dL. The post-operative day-1 computed tomography scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The patient remained asymptomatic and metabolic evaluation revealed a calcium oxalate stone, low urinary volume and hypocitraturia which were treated with potassium citrate and hydration. Conclusion: The Modified Biplanar (0-90 degree) Endoscopic-Guided Puncture Technique for Percutaneous Nephrolithotomy joins the reproducibility of the same technique under fluoroscopy with advantages regarding safety and efficiency of ECIRS.

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Use of Moses 2.0 with extended frequency and optimized Moses vs. high-power laser in MiniPCNL: a randomized controlled trial

et al. 2023

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Simplified biplanar (0–90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve

Cited by 5 publications

References 27 publications

Simplified biplanar (0–90°) versus monoplanar renal puncture technique in flank free modified supine percutaneous nephrolithotomy regarding outcomes and learning curve: Randomized clinical trial

Simplified biplanar (0–90°) versus monoplanar renal puncture technique in flank free modified supine percutaneous nephrolithotomy regarding outcomes and learning curve: Randomized clinical trial

Modified biplanar (0-90o) endoscopic-guided puncture technique for percutaneous nephrolithtomy: refinement with endoscopic combined intrarrenal surgery to reduce fluoroscopy and operative time

Use of Moses 2.0 with extended frequency and optimized Moses vs. high-power laser in MiniPCNL: a randomized controlled trial

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