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Puncturing the calyx in order to obtain access for percutaneous nephrolithotomy: the three-finger rule

Gerald Rix

This was shown to me by Sammi Moussa in Edinburgh. I perform percuta­neous nephrolithotomy (PCNL) access with the patient prone. The needle is inserted through the skin at the level of the posterior axillary line and angled so that it runs towards the calyx you are going to target. The C-arm of the image intensifier is placed at 0º in an anteroposterior (AP) setting for this. What you don’t know is whether you are too high, i.e. above the calyx, or too deep and have gone beyond it.

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