V03-08: The complete guide to a simplified Percutaneous Calyx Puncture without rotating The C-Arm
In monoplane fluoroscopy, the 0° position of the C-arm allows monitoring the needle in both the cephalo-caudal and latero-medial movements. But, how to control the depth of the needle? Mostly, the calyx is found with random tries, which become more effective with the experience of the surgeon. Is there a way to have a structured technique that will be easily and quickly performed and taught? We present a video of a step-by-step description of our simplified &[Prime]blind&[Prime] control of the needle&[prime]s depth, during percutaneous fluoroscopic calyx puncture without rotating the C-arm, in the split-leg modified lateral position.
in our routine percutaneous renal surgery, 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. The C-arm is placed in a fixed position between 10° to 15°. This position of the C-arm allows monitoring the needle in both the cephalo-caudal and latero-medial movements; the needle has to be aligned with the targeted calyx during the whole puncture. To find the kidney&[prime]s lateral edge and the calyx, in the antero-posterior plane, the needle is displaced, from posterior to anterior by small increment positions. Meanwhile, a slight jiggle of the needle is performed. To avoid parenchymal injuries, the tip of needle must be outside the renal parenchyma. It stays 1.5 to 2 cm outside the calyx. When the needle pushes the kidney and the calyx is indented, it is the correct anterio-posterior position. Then, the needle is advanced through parenchyma and just few millimeters into the calyx.
this technique of calyx puncture without moving the C-arm is feasible. It is the only technique used in our department since 1997, for more than 1000 percutaneous surgeries. 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 more than 10 centers. This technique, has been used also in the prone position, the needle is moved from up to down until the kidney moves. We think that it can be used also in the supine or supine modified position.
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 had mastered the calyx puncture and percutaneous renal surgery.