Abstract
Introduction: Careful selection and puncture of an optimal calix is a critical step for an effective percutaneous endoscopic procedure such as nephrolithotomy. This could be challenging because of the difficult anatomy of the collecting system, stone burden, and patient body habitus among several other factors. In this video, we demonstrate some tips and maneuvers for gaining safe and efficient access. This includes patient positioning for dual access, retrograde irrigation, through and through access and spine orientation for fluoroscopic guided access. Materials and Methods: In this video, some of the techniques are shown in three patients as examples. This has been used by a single surgeon on several hundreds of patients over the past 10 years. Results: In the examples mentioned earlier, the procedures were safe with effective stone clearance and relief of renal obstruction. There were no complications. Conclusions: There are several ways to perform a safe and efficient percutaneous renal access. In difficult situations, some of the maneuvers mentioned in this video may allow one to overcome challenging problems and gain safe and secure access. No competing financial interests exist. Runtime of video: 4 mins 32 secs
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