Percutaneous Calyx Puncture Without Moving The C-Arm in the split leg modified lateral position скачать в хорошем качестве

Percutaneous Calyx Puncture Without Moving The C-Arm in the split leg modified lateral position

Introduction and Objectives: during fluoroscopic percutaneous calyx puncture, the depth of the needle penetration has to be monitored with 2 planes at 0° and 30°, by moving the C-arm. Is it possible to simplify this puncture by using just one plane, and without moving the C-arm? We present the description of our technique of percutaneous fluoroscopic calyx puncture without moving the C-arm. Materials and Methods: Since 1997, in our routine percutaneous renal surgery, fluoroscopic calyx puncture is performed without moving the C-arm. The patients are placed in the split-leg modified lateral position. Percutaneous access is performed under fluoroscopic guidance, with the X-ray beam perpendicular to the tract. Thus, the operator’s hands are outside the fluoroscopic field. The C-arm is placed between 9 - 15°, which is not changed throughout the puncture. It is the equivalent of the 0° for the kidney in the prone position. This position of the C-arm allows the orientation in the frontal plan. The needle has to be aligned with the targeted calyx in this frontal plane during the puncture. The tip of needle must be outside the renal parenchyma, which is not visible during fluoroscopy. Therefore, it stays 1.5 to 2 cm outside the calyx. The needle is oriented downward below the kidney. Then, the tip of the needle is moved, blindly, from the posterior aspect to the anterior aspect, until the kidney, and then the calyx is moved. Then the needle is advanced into the calyx. Results: this technique of calyx puncture without moving the C-arm is feasible. It is the only technique used for all percutaneous surgeries in our department since 2003. We think that it is easy and quick to perform compared to puncture with moving the C-arm. In addition, in our experience this technique is easier to teach and to explain, thus many urologists had mastered the calyx puncture. Therefore, it had helped the spread of percutaneous renal surgery to many centers. In the posterior aspect of the kidney, there are no organs, so the movements of the needle from below to the aspect of the kidney are not dangerous. However, the edge of the kidney is searched by needle, the needle have to be outside the renal parenchyma. because the mobilization of the needle in the renal parenchyma might lead to parenchymal injuries. This technique, has been used also in the prone position, the needle is moved from up to down until mobilizing the kidney. We think that it can be used also in the supine or supine modified position. Conclusions: This technique of calyx puncture without moving the C-arm is feasible. We think that it can be easily performed. In addition, in our experience this technique is easier to teach and to explain, thus many urologists and centers had mastered the calyx puncture and percutaneous renal surgery.