V6-03: ADVANCED WIRE TECHNIQUES FOR COMPLEX PERCUTANEOUS NEPHROLITHOTOMY
In this video we demonstrate two wire techniques useful in complex percutaneous nephrolithotomy (PCNL).
Video of two PCNL techniques accompanied by slides and voiceover explanation of the steps.
First we explain the technique of non-dilated puncture to access stone in an excluded calyx without requiring a second dilated access. Bi-planar fluoroscopy is used to guide an 18 gauge access needle onto the stone of interest. No skin incision is required, only needle insertion. Once the needle is next to the stone on fluoroscopy a hydrophilic glidewire is advanced through the needle, past the stone and coiled in the renal pelvis. The glidewire is then directly visualized with a flexible nephroscope and brought out with graspers via the access sheath. The glidewire is followed with the flexible nephroscope to identify the exact location of the stone-containing calyx. The stone is visualized and can be basketed or lasered. This technique allows retrieval of stones from difficult to reach calyces without requiring a formal second access._x000D_ The second part of our video demonstrates use of J-tipped wire to remove multiple stone fragments and clot efficiently. A moveable core 0.035inch J-tipped wire is used. The moveable core is withdrawn to allow for a long segment of floppy tipped wire. This segment of the wire is then used to flick out small stone fragments or clots with the aid of a flexible nephroscope. The technique requires pressure irrigation to 300mmHg and an Amplatz sheath to allow free egress of the fragments. J-wire is particularly useful for calyces that are difficult to reach with the rigid nephroscope and allows for quick and atraumatic removal of small fragments. J-wire also allows relocation of stone fragments to a position that can be easily reached with a rigid nephroscope and lithotriptor._x000D_
Techniques demonstrated in this video can aid in improving PCNL stone clearance.