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. Oct-Dec 2017;33(4):319-322.
doi: 10.4103/iju.IJU_404_16.

Mini Access Guide to Simplify Calyceal Access During Percutaneous Nephrolithotomy: A Novel Device

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Free PMC article

Mini Access Guide to Simplify Calyceal Access During Percutaneous Nephrolithotomy: A Novel Device

Puskar Shyam Chowdhury et al. Indian J Urol. .
Free PMC article

Abstract

Introduction: A precise puncture of the renal collecting system is the most essential step for percutaneous nephrolithotomy (PCNL). There are many techniques describing this crucial first step in PCNL including the bull's eye technique, triangulation technique, free-hand technique, and gradual descensus technique. We describe a novel puncture guide to assist accurate percutaneous needle placement during bull's eye technique.

Methods: The mini access guide (MAG) stabilizes the initial puncture needle by mounting it on an adjustable multidirectional carrier fixed to the patient's skin, which aids in achieving the "bull's eye" puncture. It also avoids a direct fluoroscopic exposure of the urologist's hand during the puncture. Sixty consecutive patients with solitary renal calculus were randomized to traditional hand versus MAG puncture during bull's eye technique of puncture and the fluoroscopy time was assessed.

Results: The median fluoroscopy screening time for traditional free-hand bull's eye and MAG-guided bull's eye puncture (fluoroscopic screening time for puncture) was 55 versus 21 s (P = 0.001) and the median time to puncture was 80 versus 55 s (P = 0.052), respectively. Novice residents also learned puncture technique faster with MAG on simulator.

Conclusion: The MAG is a simple, portable, cheap, and novel assistant to achieve successful PCNL puncture. It would be of great help for novices to establish access during their learning phase of PCNL. It would also be an asset toward significantly decreasing the radiation dose during PCNL access.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) The mini access guide for percutaneous nephrolithotomy consists of a radiolucent cap with base diameter of 2.5 cm and two aligned tubes for maneuvering the initial puncture needle. (b) Orange tube can be rotated to correct the craniocaudal tilt and (c) white tube can be tilted medially and laterally. (d) Top view of MAG
Figure 2
Figure 2
(a) Marking the puncture point. (b) Placement of the mini access guide superimposing on the desired calyx
Figure 3
Figure 3
Adjusting mini access guide to attain bull's eye (C-arm and surface view). (a) Craniocaudal tilt being corrected. (b) Medio-Lateral tilt being corrected. (c) Bull's eye obtained and Needle introduced
Figure 4
Figure 4
(a) Needle introduced at Bull's eye position (b) C-Arm rotated to 0 degree. (c) Adjusting initial puncture needle at 0° for depth correction
Figure 5
Figure 5
Technique of using mini access guide

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