“Hybrid Technique”: To Determine the Site of Skin Puncture, Angle and Depth of Puncture in Fluoroscopy-Guided Percutaneous Renal Access in Prone Position

Abstract

Introduction: This video describes a technique to determine the site of skin puncture, angle and depth of puncture for fluoroscopy-guided percutaneous renal access in prone position.1–6 Materials and Methods: A total of 300 consecutive patients undergoing percutaneous nephrolithotomy from January 2014 had a fluoroscopy-guided access in prone position. Using the bull's eye technique, the site of skin puncture and the angle of puncture were determined. These parameters were utilized to calculate, mathematically, the depth of the targeted calix. These measurements were then utilized for puncture. The actual depth of puncture was then calculated. These measurements could be used for the bull's eye or the triangulation technique. The number of attempts, time of fluoroscopy, and the difference between estimated and actual depth were noted and analyzed. Results and Limitations: Single-attempt puncture was possible in >95% cases. No complications related to access were observed. Conclusion: This is a simple way to determine the site of skin puncture and using it one can estimate the angle and depth of puncture, making the percutaneous renal access technically less challenging. This technique could be useful especially in decreasing the learning curve for percutaneous renal access. The video describes the technique along with the principle behind it. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No competing financial interests exist. Runtime of video: 7 mins 2 secs