“All seeing needle” for micro PCNL
Percutaneous access into the collecting system is safe when using a direct puncture through the overlying renal parenchyma into the fornix of the intended calyx, to avoid major blood vessels. Direct entry into an infundibulum has a risk to injury one of the interlobar vessels or segmental branches of the renal artery, resulting in significant hemorrhage .
The mini-PCNL is a technique similar to the traditional PCNL, and it has only a smaller sheath. Therefore, the fragmentation must be conducted in a manner that you can easily extract stone fragments from the sheath but no effective rigid instruments are available that can give good results. The best method to remove the fragments is to use a basket. You can use both the ballistic lithotripter that the laser getting good results with the two methods.
The micro-PCNL is completely different from traditional PCNL because it does not allow you to extract fragments. Therefore the stone must be reduced to tiny fragments as close as possible to the pulverization. It is mandatory to use a laser that allows to achieve these result. Depending on the chemical composition of stones the laser must be set with low energy and high frequency to pulverize the stone (the setting depends on the brand of the laser). During surgery is important to remember that high power has a negative impact that can cause moving of the stone and creating large fragments. We suggest to enter the optic fiber in the center channel of the needle to avoid bending it; in the lateral canal we insert the laser fiber. In micro-PCNL you use an irrigation system connected to a pump to improve the vision; it is important that irrigation is reduced to a minimum and that the ureteral drainage is free to allow the outflow of the washing fluid.