Techniques in Percutaneous Renal Stone Surgery

Preface
Contents
Contributors
1: Anatomy for Percutaneous Renal Surgery and Access to Pelvicalyceal System
1.1 Introduction
1.2 Kidney Coverings and Relations of Other Organs
1.3 Intrarenal Vessels [3]
1.3.1 Renal Artery
1.3.2 Renal Vein
1.3.3 Pelvicalyceal System
References
2: Imaging for Percutaneous Renal Surgery
2.1 Introduction and Surgical Anatomy
2.2 Relevant Surgical Anatomy
2.3 Percutaneous Renal Access Without Image Guidance
2.3.1 Indications
2.4 The Technique
2.4.1 Complications
2.5 Conventional Imaging Using Image Intensifier (II)
2.5.1 The Technique [6]
2.6 The Triangulation Technique
2.7 Practical Tips
2.8 The Bulls Eye Technique
2.9 Other Techniques
2.10 Multiple Punctures and Different Access Modifications
2.11 Radiation Safety and Precautions
2.12 Intraoperative Ultrasonography and Obtaining the Access
2.12.1 Equipment
2.13 The Ultrasound Guided Access
2.14 Trouble Shooting
2.15 Concluding Remarks
2.16 Newer Modalities
2.16.1 Indications
2.16.2 The Technique
2.17 Preoperative Imaging for PCNL
2.17.1 Plain X-Ray (KUB)
2.17.2 X-Ray IVU
2.18 CT Scan and 3D Reconstruction Imaging for Renal Stones
2.19 Postoperative Imaging Following PCNL (Also Refer to Chapter on Residual Stones)
2.19.1 Plain X-Ray KUB
2.19.2 Antegrade Nephrostogram
2.19.3 Ultrasound
2.19.4 CT KUB
2.20 Conclusion
References
3: Preoperative Workup for Percutaneous Renal Surgery
3.1 History
3.2 Introduction
3.3 Indications for PCNL Ref. [5]
3.4 Contraindications for the PCNL Surgery
3.5 History Taking
3.5.1 Physical Examination
3.5.2 Laboratory Tests as Pre-operative Workup
3.5.3 Complete Blood Cell Count
3.5.4 Urine Analysis and Urine Culture
3.5.5 Imaging
3.6 Guy’s Stone Scoring (GSS) System Ref. [8]
3.6.1 S.T.O.N.E. Morphometry
3.6.2 CROES Nomogram
References
4: Consent for PCNL
4.1 Financial Consent
References
5: Anesthetic Considerations for Percutaneous Renal Surgery
5.1 Introduction
5.2 Pathophysiological Considerations
5.3 Management of Patients on Antiplatelet Drugs or Anticoagulants
5.4 Management of Infective Complications During and After Percutaneous Renal Surgery and the Role of Anesthesia
5.5 Technique of Anesthesia
5.6 Preparation of the Patient for Percutaneous Renal Surgery Ref. [9]
5.7 Intraoperative Considerations
5.7.1 Theater and Anesthesia Preparation
5.8 Postoperative Care of Percutaneous Renal Surgery Patients
References
6: PCNL Armamentarium: Rigid and Flexible Nephroscopes
6.1 Nephroscopes
6.2 History
6.2.1 Rigid Scope Design and Principle of Optics
6.3 Methods of Sterilisation of Rigid Nephroscopes
6.3.1 Flexible Nephroscopes
6.4 Application and Use of Flexible Nephroscopes
6.5 Sterilisation of Flexible Scopes
6.6 Newer Developments
6.6.1 Disposable Flexible Cystonephroscopes
References
7: PCNL: Lithotripsy Devices
7.1 History of Lithotripsy
7.2 Contemporary Instrumentation for Lithotripsy
7.2.1 Scientific Basis and Design Principles
7.2.1.1 Pneumatic Devices
7.2.1.2 Ultrasonic Probes
7.2.1.3 Dual Probes
Practical Tip
7.2.1.4 Cyber Wand (Dual Probe Single Technology)
7.2.1.5 Shock Pulse (Shock Pulse SE Olympus) (Single Probe Dual Modality)
7.2.1.6 Swiss Lithoclast Trilogy
7.2.1.7 Holmium YAG (Ho:YAG) Laser
Laser Fibres
7.2.1.8 Thulium Fibre Laser (TFL)
References
8: PCNL Accessories: Guide Wires and Baskets
8.1 Historical Aspects
8.2 Structure and Design of the Currently Available Guide Wires
8.2.1 Steel Guide Wires
8.2.2 Alloy-Based Guide Wires
8.2.3 Hydrophilic Guide Wires
8.2.4 Guide Wires—Which and When
8.3 Guide Wire Complications
8.3.1 Holmium Lasers and Guide Wires
8.3.2 Stone Retrieval Devices (Baskets and Forceps)
References
9: PCNL: Small to Smaller: A Journey from Max to Mini to Micro
9.1 Introduction
9.2 History of PCNL
9.3 Does Tract Size Matters?
9.4 Era of Miniaturization
9.5 Uniformity in Nomenclature
9.6 MIP in Relation to SWL, RIRS
9.7 Conclusion
References
10: “MICRO-PERC”: A Journey from Small to Very Small
10.1 Introduction
10.2 Indications [1, 2]
10.3 Microperc—The Technique
10.3.1 Clearance
10.3.2 Hospital Stays
10.3.3 Complications Associated with Microperc
10.4 How Does this Technique Fare When Compared to Other Methods?
10.5 Conclusions
References
11: Supine PCNL
11.1 Supine Patient Positioning
11.2 Operating Room Set-Up for Supine PCNL
11.3 Patient Positioning and Marking (Figs. 11.1 and 11.2)
11.4 Operative Room Setup (Fig. 11.3)
11.5 Operative Procedure
11.6 Surgical Indications for Which Supine Position is Used for Antegrade Access to Kidney
11.7 Advantages of Doing PCNL in Supine Position
11.8 Success Rates of PCNL in Supine Position
11.8.1 Is Supine Position Effective in Special Situations?
11.8.2 Disadvantages of Supine Position
11.9 Conclusion
References
12: PCNL Complications
12.1 Introduction, Incidence, and Classification
12.2 Specific Complications in PCNL
12.2.1 Bleeding
12.2.2 Damage to the Collecting System
12.2.3 Infection and Sepsis
12.2.4 Organ Injury
12.2.5 Other Complications
12.3 Prevention and Prediction of Complications
12.4 Identification of High-Risk Patients
12.5 Conclusion
References
13: PCNL: Bleeding Complications and Their Prevention
13.1 Why Is There a Risk of Hemorrhage in PCNL?
13.1.1 Pathophysiology of Bleeding Post PCNL
13.1.2 What are the Measures to Control/Contain Bleeding?
13.1.3 What are the Factors Affecting Blood Loss?
13.2 Clinical Presentation in Cases of Bleeding Following PCNL
13.3 Fate of Intraoperative and Perioperative Bleeding
13.3.1 Venous Bleeding
13.3.2 Arterial Bleeding
13.4 Algorithm for the Management of Intraoperative Bleeding
13.4.1 Postoperative Hemorrhage
13.4.2 Pathophysiology of Delayed Hemorrhage
13.4.3 Management
13.4.4 How Do You Manage Venous Hemorrhage During PCNL?
13.4.5 What To Do If Placement of the Sheath and Removal of Clots Does Not Restore Vision?
13.4.6 Indications for Angiography
13.4.7 Complications of Angiography and Selective Angioembolization
13.4.8 Management of Perinephric Hematoma
13.5 Role of Medical Therapy in Preventing or Reducing Hemorrhage Following PCNL
13.5.1 Tranexamic Acid
References
14: Exit Strategies for PCNL
14.1 Introduction
14.2 Options
14.2.1 Is the Size of the Nephrostomy Tube Important?
14.2.2 Is Nephrostomy Tube Needed for Haemostasis?
14.2.3 Is Nephrostomy Needed for Drainage?
14.2.4 Types of Nephrostomy Tubes
14.2.5 Tubeless PCNL
14.2.6 Adjuncts to Tubeless PCNL
14.3 Special Situations
14.3.1 Multiple Tracts
14.3.2 Supracostal PCNL
14.3.3 Emergency Exit
14.3.4 Bleeding
14.3.5 Perforation
14.4 Summary
References
15: Residual Stones and Management
15.1 Residual (Retained?) Fragments and Recurrent Stones Following PCNL
15.1.1 The Management and Postoperative Imaging Protocol
15.1.2 Residual Fragments (RF)
15.1.3 Clinically Insignificant Residual Fragments (CIRF)
15.1.4 Recurrent Stones
15.1.5 Postoperative Imaging Modalities
15.1.6 Residual Fragments Following PCNL and Their Fate
15.1.6.1 Why Do Stones Remain?
15.1.6.2 Consequences of the Residual Stones
15.1.6.3 Why Do We Need to Watch the Residual Stones?
15.1.7 Prevention Strategies for the Residual Fragments
15.1.7.1 Pre-operation Planning
15.1.8 Intraoperative Measures
15.1.9 Treatment of Residual Fragments
15.2 Review of Literature
15.3 Conclusion
References
16: Training for PCNL
16.1 The Essentials of PCNL Training
16.2 Operating Room Learning Opportunities
16.3 PCNL Simulation Today
16.3.1 Animal Laboratory
16.3.2 Simulation Laboratory
16.4 High-Fidelity Fluoroscopy Free Simulators
16.4.1 Why Are These Needed?
16.4.2 Low- and Mid-Fidelity Simulators
16.4.2.1 Perc Trainer™
16.4.3 3D Printed Models [11] (Fig. 16.2)
16.4.4 Rawandale’s PCNL Simulator [12] (Fig. 16.3)
16.5 Biological Bench Models
16.5.1 Vegetable Model
16.6 Low-Fidelity Fluoroscopy Free Simulators
16.6.1 SimPortal CAT Simulation Model
16.6.2 Rawandale’s Virtual Fluoroscopy PCNL Simulator (Fig. 16.5 a, b)
References
17: Tips and Tricks for PCNL
17.1 Preoperative Imaging
17.2 Study the Patient’s Parameters
17.2.1 Per-operative Considerations
17.2.2 Points to Consider in the Operative Room
17.2.3 Surgical Trouble Shooting
17.2.3.1 Access Difficulty
References
18: Stone Evaluation—Biochemical Analysis and Its Clinical Implications
18.1 Urinary Stone Evaluation in Laboratory: Why and How?
18.2 Why Do Stones Form?
18.2.1 Theories of Stone Formation in Brief
18.2.2 Algorithm for the Initial Evaluation of the Patient Presenting with a Kidney Stone
18.3 Overview of Currently Used Techniques for Stone Analysis
18.3.1 Composition and Hardness Factor of Stones and Its Significance
18.3.2 Summary of Biochemical Abnormalities in Various Stone Compositions
18.3.3 What’s New in Stone Composition Analysis?
18.4 Conclusion
References
19: PCNL: Future Directions
References