V03-06: Cross-Table Bullseye For Percutaneous Nephrolithotomy
The &[Prime]eye of the needle&[Prime] or &[Prime]bullseye&[Prime] technique is a commonly performed access technique for prone percutaneous nephrolithotomy (PCNL). We have created a novel puncture method for supine PCNL called the &[Prime]cross table bullseye,&[Prime] which incorporates aspects of the prone technique and simplifies supine puncture.
The technique consists of three steps: A retrograde pyelogram is taken in the AP view to determine the collecting system anatomy; then the c-arm is rotated 90 degrees to determine the location of the calyces in the anterior-posterior plane and their corresponding skin entry sites; and then the c-arm is rotated back to the AP view to guide the puncture of the kidney with the needle parallel to the floor, moving only in the cranial-caudal plane.
Video and fluoroscopic footage taken from several procedures demonstrated the success of the obtaining percutaneous renal access using the fluoroscopic cross-table bullseye technique. The steps involved in the successful supine percutaneous renal access were identified and described in both written captions and audio narration.
In our experience, the cross-table bullseye technique simplifies supine percutaneous renal puncture by using and adapting aspects of the well-known &[Prime]bullseye technique&[Prime] for prone percutaneous access.