V1723: Upper calyxes percutaneous access using the renal displacement with the 18-gauge puncture needle.

Video

Introduction and Objectives
We present a video of our experience of percutaneous renal upper pole access using a percutaneous renal displacement technique, to render the superior calyx reachable below the 11th rib. We describe a renal displacement technique using an 18-gauge needle, and its use in different situations.

Methods
The needle renal displacement technique is performed under fluoroscopic guidance, with the X-ray beam perpendicular to the tract. Initially, a lower or middle calyx is punctured with an 18-gauge diamond-tipped needle. A stiff-shaft hydrophilic guidewire is inserted to protect urothelium from the needle-tip. The needle's proximal-end is progressively pushed in the cephalic direction. Consequently, the kidney is displaced caudally, by the lever manoeuvre. Secondly, the upper pole calyx is punctured, for tract formation.

Results
Renal displacement has always been possible in kidneys with no surgical history. However, it failed when the kidney was fixed by post-surgical-adhesions. A caudal renal displacement, of many millimeters to few centimeters, is gained. There is also a slight inversion of the normal axis of the kidney. The renal upper pole becomes more accessible to puncture below the 11th-rib or even the 12th-rib, so decrease of intra-thoracic morbidity. This technique has also been used to immobilize mobile kidneys or to reorient complex malrotated kidneys.

Conclusions
percutaneous needle renal displacement technique may render the superior calyx more available while avoiding or decreasing intra-thoracic complications, but are effective only when the kidney is mobile. This technique can be used to perform some calyx reorientation and to fix very mobile kidneys.

Funding: none