V9-08: Micro-Ecirs: our intial experience for the treatment of kidney stones
VideoIntroductions and Objectives
ESWL and RIRS represent the gold standard in the treatment of 10-20 mm kidney stones. However, these procedures could require repeated sessions or ancillary maneuvers. Therefore, in selected cases, a percutaneous approach is indicated to offer a higher success rate even if a greater invasiveness is the price to pay. The recent introduction of micro-percutaneous technique using instruments with small diameter may be a good compromise between the effectiveness of the procedure and its invasiveness. The entire procedure is indeed performed using a 4.85 F needle, 0.9 mm micro-optical system and a 200 micron Ho laser fiber. By using these instruments, no dilation is required for the creation of nephrostomy tract, thus the trauma on renal parenchyma and the morbidity are reduced. We present our initial experience with Endoscopic Combined Intra Renal Surgery by using this micro-instrumentation (micro-ECIRS). We present our initial experience (3 cases) with endoscopic combined intrarenal surgery by using this micro-instrumentation (micro-ECIRS).
All the procedures were performed with the same technique: - Patient is placed in supine position according to Valdivia modified Galdakao - Preliminary retrograde semi-rigid ureteroscopy is performed - An ureteral sheet is placed to decrease the intrarenal pressure and increase the fragments stone clearance - Punctures is performed with ultrasound and fluoroscopy guidance - Then a flexible ureteroscopy is performed to evaluate the anatomy of the collecting sistem, the stones charateristics and to control the renal puncture under endovision - Finally a 200 micron Ho laser fiber was inserted and lithotripsy was performed with Ho laser - At the end of the procedure a retrograde inspection was done to remove residual fragments
Mean operative time was 116 minutes, blood losses were virtually absent. There were no intra- or post-operative complications. In all cases a double-J endoureteral stent was placed in a retrograde fashion whilst no percutaneous catheter was required. All the patients were discharged on first post-operative day, the ureteral stent was removed on third post-operative day.
Our initial experience suggests that micro-ECIRS seems to be feasible and safe. with minimal invasiveness. However, further studies are needed to better understand the safety and efficacy of the technique and to clearly identify those patients who can benefit from the procedure.