The access to the upper calyx in supine position is challenging due to potential drawbacks, such as proximity to surrounding organs, intercostal access, risk of bleeding and longer skin-stone distance. A direct access to the upper calyx can be avoided, using flexible endoscopes from the lower calyx or the ureter. However, in complex cases such as large stone burden or unfavorable anatomy for the use of flexible instruments, it is necessary to enter directly into the upper calyx to solve the lithiasis in a single procedure. The aim of the video is to illustrate how, in these cases, ultrasound-guided puncture and miniperc make the access to the upper calyx in supine position much safer.
Five clips showing five cases of complex renal lithiasis solved with this minimally invasive approach.
All the clips show:
- CT scan images to identify and locate the stones and determine their position regarding surrounding organs;
- radiological images during procedure to determine and illustrate the strategy;
- endoscopic images of the procedure;
- final result.
All cases were solved successfully and without significant complications. Average surgical time was 110 min. All the patients were discharged between 48-72 h.
Ultrasound-guided puncture and minipercutaneous access make the approach to the upper calyx in the supine position much safer.