needle renal discplacement technique for renal superior calyx access скачать в хорошем качестве

needle renal discplacement technique for renal superior calyx access

needle renal displacement technique for percutaneous renal upper pole puncture We describe a new renal displacement technique using an 18 gauge needle, to facilitate the puncture of the superior calyxes and to decrease intra-thoracic morbidity. When the kidney is high located, a lower or middle calyx is punctured with an 18 gauge needle, and while pushing the proximal end of the needle in the cephalic direction; the kidney is pushed caudally by the lever maneuver. This needle displacement technique can also be used for orientation of malrotated kidney or help immobilizing the kidney. In the beginning of our experience we had a concern about the risk of shear injury to the renal parenchyma or urothelium by the distal end of the needle during its movement so we performed an endoscopic control of the first point of entry by a flexible or directly rigid nephroscope when possible, and we had noted no hemorrhage or urethelium laceration. That is why we use a stiff shaft hydrophilic guide wire to push urethelium and calyx in the point of pressure of the needle tip, and a chiba tip needle must not be used because of its sharp tip. We had used this technique the other way around, by displacing the kidney in cephalic direction via a central calyx to reorient a more medial lower calyx. This needle renal displacement technique was also used for immobilizing the kidney or reorientation of complex and malrotated kidneys by moving the proximal end of the needle upward or downward.