combined direct visual and imaging guided percutaneous nephrolithotomy: a novel technique

Introductionpercutaneous nephrolithotomy (pcnl) is a common urological procedure. obtaining secure percutaneous access to the collecting system which is usually done under fluoroscopic guidance and tract dilatation is a crucial step toward a successful and safe procedure. this study aims to introduce a novel technique to modify this procedure.methodcombined direct visual and imaging guided pcnl is performed by using specific 28 fr dilatators with a customized central lumen that accepts a 4.5 f semi-rigid ureteroscope to visually confirm the puncture of the target calyx and passing a guidewire. this instrument was passed as a one-shot dilator after the withdrawal of the puncture needle. the rest of the procedure was then carried out in a standard manner. this novel technique was introduced to 12 patients in 2020 in sina hospital, after completing the informed consent.results the mean age was 53.58±11.96 and the average stone size was 4.1±0.58 cm and the average time from insertion of the needle into the target calyx until securing a guide wire inside the collecting system (pelvis, ureter) was 95 seconds (84-107). fluoroscopy time (total time required to obtain the access but not the whole operation) was on average 30.25±8.01 seconds. there were no intraoperative or postoperative complications as a result of this technique.conclusionsthe use of the ureteroscope loaded with the dilator and sheath during pncl seems to be a feasible and safe technique for dilatation of the access tract during one shot pcnl.