A Different and Novel Alternative (ADANA) Renal Access Technique when CT or USG Guidance Is Inadequate in Case of Retro-Renal Colon

Abstract

Introduction: Computed tomography (CT) or ultrasonography (USG)-guided renal access for percutaneous nephrolithotomy (PNL) is not suitable in all cases with retro-renal colon (RRC) due to anatomical and technical restrictions. We would like to describe our novel technique that permits standard subcostal renal access with a small incision for these patients. Methods: This method was performed on adult patients with severe RRC and complex renal stones who were not suitable for renal access with CT or USG guidance. Time from skin incision to puncture needle insertion, incision length, stone-free rate (SFR), and complications were evaluated. Surgical Technique: The appropriate renal calyx for renal access was identified with retrograde pyelography. The skin closest to the identified calyx was incised and retroperitoneum visualized. The RRC was swept laterally by blunt dissection to obtain a safe puncture line. The retractors were placed to keep the colon away from the incision. Then, the puncture needle was placed over Gerota’s fascia. After this, the puncture needle was inserted into the targeted calyx under fluoroscopic guidance. The insertion of guidewire and the rest of the procedure such as dilatation and insertion of Amplatz sheath were performed under same maneuver. Results: A total of 1,348 patients were treated with PNL between January 2016 and November 2019. Our group consisted of 16 adult patients with a median age of 44.8 years (7 females and 9 males) who underwent PNL with our new access technique. SFR and clinically insignificant residual fragment (CIRF) rate were 72.5 and 14.2%, respectively. The median access time was 22.2 min (range: 15–30 min). The median skin incision length was 3.7 (range: 3.0–4.5) cm. The average skin incision length was 3.7 cm. The SFR and CIRF rate were 72.5 and 14.2%, respectively. We did not observe any complication related to our access technique. Conclusion: Our novel access technique created a safe anatomical route for standard subcostal renal access with acceptable incision length and very low complication rate.