PCNL - the Perfect Puncture

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Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore

Gesundheit & Medizin

PCNL – Tips and Tricks for a Good Puncture Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital

What is a perfect puncture ? ,[object Object],[object Object]

Minimize injury to kidney ,[object Object],[object Object],[object Object]

Obtaining a good puncture ,[object Object],[object Object],[object Object],[object Object],[object Object]

Planning the puncture - Imaging ,[object Object],[object Object],[object Object],[object Object]

Planning the puncture - Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Posterior vs anterior calyx ,[object Object],[object Object],[object Object],[object Object],[object Object],Anterior middle Posterior middle

End on puncture with straightest path along stone axis ,[object Object]

End on puncture with straightest path along stone axis

Dilated calyx ,[object Object],[object Object],[object Object]

Mid pole puncture ,[object Object],[object Object],[object Object]

Single or multiple punctures ,[object Object],[object Object],[object Object],[object Object],[object Object]

Single or multiple punctures ,[object Object],[object Object],[object Object],[object Object]

Retrograde catheter ,[object Object],[object Object],[object Object]

Positioning of patient ,[object Object],[object Object]

Positioning of patient and surgeon Irrigation, Contrast Nurse Surgeon Fluoro Fluoro view Camera

Puncture needle ,[object Object],[object Object]

Puncture and dilate in 2 planes ,[object Object],[object Object],[object Object],[object Object]

Lower pole puncture – 2 plane technique ,[object Object],[object Object],[object Object],[object Object],[object Object]

Lower pole puncture ,[object Object],[object Object],[object Object],Kidney Kidney

[object Object],[object Object],[object Object],Lower pole puncture

Lower pole puncture ,[object Object],[object Object],[object Object]

Upper pole puncture - bull’s eye technique ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Upper pole puncture Calyx Kidney

Upper pole puncture – how to avoid injury ,[object Object],[object Object],[object Object],[object Object],Post axilla line 11 12

Pleura injury ,[object Object],[object Object],[object Object]

Non opacification of collecting system ,[object Object],[object Object]

Undilated system ,[object Object],[object Object]

Undilated system ,[object Object],[object Object],[object Object]

What to do after a good puncture ? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Take home message ,[object Object],[object Object],[object Object],[object Object],[object Object]

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