Ultrasound Guided Access for Percutaneous Nephrolithotomy In Supine Position
Suprita Krishna, Ruslan Korets, Kenneth Softness
Beth Israel Deaconess Medical Center, Boston, MA, USA
This video describes a step-by-step approach to ultrasound-guided access for percutaneous nephrolithotomy. For this procedure, the patient is positioned in Galdakao modified supine Valdivia position with the ipsilateral flank elevated with gel rolls. Access is gained using an ultrasound probe and an 18G 15cm or 20cm needle. Tract dilation is performed in the usual fashion, and this technique can be used for both standard and mini-PCNL.
Some of the key advantages of this technique are 1. easier airway and anesthetic management, 2. improved drainage of fluid and stone fragments from the kidney, 3. decreased radiation exposure, 4. easier antegrade and retrograde access, 5. improved operative ergonomics
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