Large Working Channel Research Articles

Clinical evaluation of a novel therapeutic single-use gastroscope: a pilot feasibility study.

The trend toward disposable products in gastrointestinal endoscopy, including single-use endoscopes, remains undeterred, even though crucial questions of sustainability and performance have not been sufficiently studied. The first therapeutic single-use gastroscope (Ambu aScope Gastro Large) was recently approved in Europe, but clinical data to support its use is currently unavailable. We aimed to evaluate the performance of the Ambu aScope Gastro Large in routine procedures requiring a large working channel. Between January and May 2024, consecutive patients with an indication for therapeutic gastroscope use were included prospectively. The primary aim was to assess the intraprocedural technical success rate. Eight gastrointestinal bleedings, two pancreatic necrosectomies, four foreign body removals, four stent implantations, and two cryoablations were performed. The technical success rate was achieved in 16 out of 19 (84%) patients. Three crossovers to standard endoscopes occurred. Clinical success was achieved in all cases where the primary aim was achieved (85%). No adverse events were reported. The therapeutic single-use gastroscope demonstrated feasibility in various therapeutic procedures, however, a crossover rate of 16% and an average user quality assessment score of 3.2 on the Likert scale suggest that further technical improvements of the device are necessary.

Deep enteroscopy - what's new and what works best?

We aim to review the types of device-assisted deep enteroscopy endoscopes, tips for a successful procedure as well as areas for improvement. Deep enteroscopy allows for diagnostic and therapeutic intervention of the small bowel and can be used as an adjunct to video capsule endoscopy to improve the yield and management of small bowel lesions. Our top tips for deep enteroscopy success include reviewing patient history and prior imaging, utilizing CO 2 insufflation or water exchange, verifying quality measures and emphasizing ergonomics. With these, endoscopists can optimize patient outcomes while minimizing occupational risks. New aspects of deep enteroscopy equipment focus on high-resolution imaging, a larger working channel, and enhanced scope angulation. Proposed improvements include developing innovative technology to optimize the color and clarity of the high-resolution imaging, minimizing the number of staff required for the procedure, and decreasing ergonomic strain.

Full-Endoscopic Foraminoplasty and Lumbar Discectomy for Single-Level Lumbar Disc Herniation.

The Transforaminal Endoscopic Surgical System (TESSYS) technique has gained popularity for the treatment of lumbar disc herniations. Foraminoplasty is the key procedure in TESSYS. However, it requires advanced skills and long-term learning, which hinder its widespread adoption among surgeons. Recently, the introduction of full-endoscopic solutions has made the process more manageable. The main difference from traditional single-portal endoscopic surgery is that full-endoscopic surgery is equipped with a larger working channel, allowing full visualization of foraminoplasty and decreasing reliance on intraoperative fluoroscopy. Recently, published studies have shown that full-endoscopic foraminoplasty and lumbar discectomy (FEFLD) could achieve comparable results to conventional microdiscectomy in terms of pain relief and functional outcomes, while enhancing postoperative recovery. This study describes the technique of FEFLD in detail, including every crucial step, such as patient positioning, puncture trajectory, endoscopic dissection of the superior articular process (SAP), endoscopic foraminoplasty, and more. We hope this will be helpful to beginners who wish to apply this approach.

Prodrome to Seizure in Transforaminal Endoscopic Surgery: A Series of 9 Cases

Objective: Percutaneous transforaminal endoscopic lumbar discectomy (PTELD) is safe and ef- fective. Perioperative or postoperative seizures are a rare complication that can be prevented by promptly identifying prodromal symptoms and signs. This study aimed to identify prodromal symptoms and risk factors of avoidable seizures in patients undergoing PTELD and to quantify irrigation fluid ingression into the epidural space on immediate postoperative magnetic reso- nance imaging (MRI).Methods: This retrospective analysis included patients who underwent PTELD under local anes- thesia from February 2018 to June 2022. Surgical records were reviewed to identify patients who developed prodromal symptoms, and immediate postoperative MRI was evaluated for ra- diological correlations.Results: Nine patients developed prodromal symptoms of neck pain (n = 6), upper dorsal pain (n = 7), headache (n = 2), confusion (n = 2), visual disturbance (n = 1) and hemodynamic alter- ations (n = 4). No patients had seizures. Calcified lumbar disc herniation-associated posterior apophyseal ring fracture, central lumbar disc herniation, obesity, double-level surgery, use of an automated pump, and a large working channel endoscope were associated with an increased fluid flow rate for epidural work and duration of surgery. MRI showed significant epidural fluid collection cranial to the operative level, reaching the thoracolumbar junction, in patients with prodrome, suggesting increased intracranial pressure due to thecal sac compression. Conclusion: Prodromal symptoms should be considered a red flag for avoidable seizures. The duration of surgery and infusion fluid flow rate are controllable risk factors during surgery. Risk factors should be kept in mind. The judicious use of automated pumps and larger channel work- ing endoscopes is recommended.

Feasibility study of endoscopic biliary drainage under direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos).

The therapeutic utility of peroral cholangioscopy (POC) is limited. Direct POC using an ultra‑slim upper endoscope expands the therapeutic indications because of its larger working channel, of up to 2.2 mm. We evaluated the feasibility of selective biliary drainage using a plastic stent under direct POC. From April 2015 to March 2019, biliary drainage under endoscopic visualization was performed in the same endoscopic session as direct POC without exchanging the duodenoscope. After guidewire insertion through the stricture or stone, a 5 Fr plastic stent and/or nasobiliary drainage catheter was used for biliary drainage. Selective biliary drainage under direct POC was performed in 32 patients, including 17 with difficult bile duct stones. Biliary drainage was performed with a plastic stent in 29 patients, nasobiliary drainage in one, and combined drainage in two patients. The technical success rate for biliary drainage placement under direct POC was 100 % (32/32). No significant procedure-related complications occurred. In conclusion, biliary drainage with a plastic stent or catheter under direct POC using an ultra-slim upper endoscope is feasible and may be useful for lesions obstructing the bile duct.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Su1435 ANALYSIS OF THE THERAPEUTIC SHORT DOUBLE BALLOON ENTEROSCOPE ASSISTED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PATIENTS WITH SURGICALLY-ALTERED PANCREATICOBILIARY ANATOMY

Endoscopic Retrograde Cholangiopancreatography (ERCP) in patients with surgically-altered GI anatomy remains a technical challenge. Single balloon enteroscope (SBE) and double balloon enteroscope (DBE) assisted ERCP have been used with some limitations due to small working channel (2.8mm) and scope length (2300mm). The newly developed therapeutic short double-balloon enteroscope (T-sDBE) with 3.2 mm working channel and 1550 mm working length allows an easier handling of accessories designed for therapeutic ERCP. However, the existing data about this device is limited. This study aimed to assess the technical success of T-sDBE and compared it to conventional balloon-assisted enteroscope (C-BAE). A retrospective study of ERCP database during 2009-2019. Patients with surgically-altered GI anatomy undergoing BAE-ERCP were reviewed. Types of BAE included T-sDBE (EI-580BT), and C-BAE including DBE (EN-580T) and SBE (SIF-Q180). Definitions: enteroscopy success = able to reach ampulla, technical success = able to perform intervention, and clinical success = resolution of symptoms and normalization of bilirubin level. Forty-eight patients underwent 101 ERCP procedures: 75% C-BAE and 25% T-sDBE. The majority of surgical anatomy were Roux-En-Y hepaticojejonostomy (RYHJ) (55.4%), Whipple (23.8%), Billroth II (5.9%). The common diagnosis included bile duct stone (61.4%), anastomotic stricture (44.6%). The overall technical success rate was 62.4% (95% CI 52.5-72.3%), and clinical success rate was 59.4% (95%CI 49.5-69.3%). Seventy-eight interventions were performed including biliary stent insertion (90%), balloon dilation (28%), and stone extraction (18%). Adverse events occurred in 4% and all were post-ERCP cholangitis. When compared to the C-BAE, the T-sDBE was equivalent in terms of enteroscopy success (66.2% vs 72.0 %, p=0.593), and technical success (59.5% vs 68.0%, p=0.448) (Table 1). Among those with enteroscopy success, both T-sDBE and C-BAE provided high technical success of 94.4% and 89.8% (p=1.0) respectively. In patients with long limb such as RYHJ, the sDBE offered an equally good enteroscopy and technical success as C-BAE (75% Vs 71.1%, p=1.0 and 91.7% Vs 88.9%, p=1.0 respectively). The T-sDBE was as effective as C-BAE in regard to enteroscopy success. However, an increased technical success was not demonstrated despite larger working channel in our study cohort where most of the interventions required was biliary stent placement for the treatment of biliary anastomotic stricture in RYHJ anatomy. Further studies are required to better assess the benefits of this new device.

Fully-endoscopic lumbar laminectomy for central and lateral recess stenosis: Technical note

Abstract Background Lumbar central and lateral recess stenosis that results from a degenerative bulging of the disc and overgrowth of the facet is a very common cause for lumbar claudication and radiculopathy in the elderly. The standard surgical treatment for symptomatic lumbar central and lateral recess stenosis often requires a laminectomy. The evolution of minimally invasive techniques have created advantages for patients undergoing surgery and the authors present here a novel technique for endoscopic access to the central and lateral recess pathology that is truly minimally invasive and offers several advantages to minimally invasive spine surgeon. Methods 14 cases were performed, 10 at L4–5 and 4 at L5-S1, for the treatment of central and lateral recess stenosis. The technique was similar to that performed for minimally invasive lumbar laminectomies with a tubular retractor except, after percutaneous access to the pathological level, a cannulated 11.5 mm tubular retractor was inserted and then a 10 mm outer diameter laminoscope with a 6 mm working channel and 15° lens was inserted. Specialized endoscopic drills, forceps, and kerrison rongeurs were used to remove bony pathology and ligamentum flavum under direct visualization. Results Following surgery, the patients' symptoms showed immediate regression with continued relief at 6 month and 1 year follow up visits. Conclusions The availability of endoscopes with larger working channels (laminoscopes) and larger endoscopic instruments and drills now makes treating significant central and lateral recess lumbar stenosis with endoscopic techniques more feasible.

A multicenter experience of through-the-scope balloon-assisted enteroscopy in surgically altered gastrointestinal anatomy.

Surgically altered gastrointestinal anatomy poses challenges for deep enteroscopy. Current overtube-assisted methods have long procedure times and utilize endoscopes with smaller working channels that preclude use of standard accessories. A through-the-scope balloon-assisted enteroscopy (TTS-BAE) device uses standard endoscopes with a large working channel to allow metallic and plastic stent insertion. We aim to determine the efficacy and safety of TTS-BAE in patients with altered surgical anatomy. A retrospective, multicenter study of TTS-BAE in altered anatomy patients at two USA and one German institution was performed between January 2013 and December 2014. Type of anatomy, procedure indication and duration, adverse events, and target, technical, and clinical success were recorded. A total of 32 patients (mean age 54years, Caucasian 81.6%, female 42.1%, mean BMI 25.4kg/m2) underwent 38 TTS-BAE procedures. Thirty-two percent of cases had a prior attempt at conventional enteroscopy which failed to reach the target site. The target was successfully reached in 23 (60.5%) cases. Of the 23 cases that reached the intended target, 22 (95.7%) achieved technical success and 21 (91.3%) achieved clinical success. The median procedure time was 43min. Target, technical, and clinical success rates for TTS-BAE-assisted ERCP (n=31) were 58.1, 54.8 and 54.8%. Seven self-expandable metallic stents (five biliary, two jejunal) were attempted, and all successfully deployed. Adverse events occurred in 4 (10.4%) cases, including one luminal perforation. TTS-BAE is an alternative to overtube-assisted enteroscopy that is comparable in safety in patients with surgically altered anatomies. Technical success in the instances where the target had been reached was excellent. TTS-BAE confers an advantage over overtube-assisted enteroscopy as it can facilitate the deployment of self-expandable metallic stents in the biliary tree and deep small bowel.

Through-the-scope enteral metal stent placement using a short-type single-balloon enteroscope for malignant surgically reconstructed jejunal stenosis (with video).

Self-expandable metal stent (SEMS) placement in surgically reconstructed intestine is technically challenging, and only a few reports have been published.1, 2 Here, we describe a case of successful SEMS placement for surgically reconstructed jejunal stenosis using a newly developed short-type single-balloon enteroscope (sSBE). A 70-year-old man presented to our hospital with fever and jaundice. Six months earlier, he had undergone subtotal stomach-preserving pancreatoduodenectomy with PD-II reconstruction for duodenal cancer. Computed tomography revealed a dilated intrahepatic bile duct as a result of stenosis in the surgically reconstructed jejunal loop caused by cancer recurrence (Fig. 1a). We could reach the stenosis using a sSBE (SIF-H290S; channel diameter, 3.2 mm; Olympus, Tokyo, Japan); however, it was impossible to pass beyond the stenosis (Fig. 1b). Because of the advanced stage of cancer, palliative through-the-scope (TTS) SEMS placement was attempted. A 0.035-inch guidewire was advanced beyond the stenosis, and an uncovered SEMS (18-mm wide, 80-mm long; Niti-S Enteral Colonic Stent; Taewoong Medical, Gimpo, Korea) was deployed (Fig. 2, Video S1). The postoperative period was uneventful. Jaundice and cholangitis resolved in a few days. Abdominal X-ray revealed that the stent was well expanded. The sSBE is compatible with the use of various interventional devices through its large working channel. To date, there is only one report on TTS SEMS placement, but it used a short-type double-balloon enteroscope (DBE).3 In comparison with DBE, SBE was assumed to be more disadvantageous in carrying out deep insertion.4 Having been equipped with a passive bending part, the sSBE has an increased endoscope flexibility. A recent article using sSBE showed its success rate of insertion to the blind end to be 92%.5 Although the safety of SEMS placement in the jejunum is yet to be established, TTS SEMS placement using sSBE could be an effective, minimally invasive treatment option for patients with advanced cancer. Authors declare no conflicts of interest for this article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Types of Peroral Cholangioscopy: How to Choose the Most Suitable Type of Cholangioscopy.

A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct. Currently available types of peroral cholangioscopy include peroral videocholangioscopy (POCS) using a mother-baby scope system (MBSS), direct peroral videocholangioscopy (D-POCS), and SpyGlass™ Direct Visualization System (SGDVS). POCS started with cholangioscopy using MBSS, requiring two skilled endoscopists using two endoscopic systems. On the other hand, D-POCS and SGDVS were developed as single-operator techniques. In MBSS, the videocholangioscope is inserted into the bile duct through the accessory channel of a conventional therapeutic duodenoscope. MBSS enables comparatively easy scope insertion into the bile duct and stable scope positioning. POCS using MBSS provides excellent images and can be coupled with an image-enhanced function system. However, it has a smaller accessory channel, limiting the devices that can be used. Additionally, scope fragility is serious problem. D-POCS using an ultraslim upper endoscope has been introduced to overcome the drawback of POCS using MBSS. D-POCS has a larger working channel and requires only one endoscopist. D-POCS allows a greater variety of procedures under excellent imaging even with an image-enhanced function system; however, scope insertion is still challenging. SGDVS is designed for single-operator use and is dedicated to procedural purposes. It comprises a reusable optical probe and disposable delivery catheter, which has four-way deflected steering and dedicated irrigation channels. These features lead to good maneuverability, although image quality is poor due to its optical probe system. All systems' features should be recognized and the appropriate system used depending on the need. Cholangioscopy has shown dramatic progress from diagnosis to therapy with high future growth potential.

A Case of Afferent Loop Syndrome Treated by Endoscopic Metal Stent Insertion Using Two Endoscopes

들창자 증후군의 ë¹„ìˆ˜ìˆ ì  치료 방법은 다양하지만 ì–¸ì œë‚˜ ëª¨ë“ ë°©ë²•ì´ 다 ì ìš© 가능한 것은 아니다. 특히 ë‚´ì‹œê²½ì  치료 방법은 í•´ë¶€í•™ì  변형으로 인해 병변으로의 ì ‘ê·¼ì— ì œí•œì ì´ 있다. 이에 ì €ìžë“¤ì€ ì• ì„± ì¢ ì–‘ìœ¼ë¡œ 인한 들창자 증후군 환자에서 2개의 내시경을 이용하여 ì„±ê³µì ìœ¼ë¡œ ê¸ˆì†ìŠ¤í íŠ¸ë¥¼ ì‚½ìž í•œ 사례를 문헌 ê³ ì°°ê³¼ 함께 ë³´ê³ í•˜ëŠ” 바이다. 중심 단어: 들창자증후군; ì·Œì‹­ì´ì§€ìž¥ì ˆì œìˆ ; 췌장암; 내시경

Improvements and innovations in endoscopic ultrasound guided fine needle aspiration.

Keywords: Algorithm; Core histology needle; Cytology; Endoscopic ultrasound guided fine needle aspiration fine needle biopsy; Histology

The modern history and evolution of percutaneous nephrolithotomy.

Serendipity, innovative physicians, evolving techniques for renal access, and improvements in equipment and radiology led to the evolution of percutaneous nephrolithotomy (PCNL). We searched urology texts and the literature for sources pertaining to the history and development of PCNL. In 1941, Rupel and Brown performed the first nephroscopy when a rigid cystoscope was passed into the kidney following open surgery. Willard Goodwin, in 1955, while trying to perform a renal arteriogram, placed a needle into the collecting system of a hydronephrotic kidney and performed the first antegrade nephrostogram. He left a tube to drain the kidney, thereby placing the first nephrostomy tube. By 1976, Fernström and Johansson were the first to describe a technique for extracting renal calculi through a percutaneous nephrostomy under radiological control. In 1978, Arthur Smith, would describe the first antegrade stent placement when he introduced a Gibbons stent through a percutaneous nephrostomy in a patient with a reimplanted ureter. Dr. Smith would coin the term "endourology" to describe closed, controlled manipulation of the genitourinary tract. His collaboration with Kurt Amplatz, an interventional radiologist and medical inventor, would lead to numerous innovations that would further advance PCNL. In the 1980s the process of renal access and tract dilation was improved upon and the use of a rigid cystoscope was replaced by offset nephroscopes with a large straight working channel. Radiographic innovations, including improvements in fluoroscopy would further aid in renal access. The development of various lithotripsy devices and the introduction of the holmium laser improved the efficiency of stone fragmentation and clearance. The increased clinical experience and utilization of PCNL would lead to the characterization of stone-free rates and complications for the procedure. Serendipity, innovations in renal access, optics, radiology, and improvements in lithotripsy all contributed to the modern day PCNL.

Feasibility of respiratory motion-compensated stereoscopic X-ray tracking for bronchoscopy

Precise localization in bronchoscopy is challenging, particularly for peripheral lesions that cannot be reached by conventional bronchoscopes with a large working channel. Existing navigation methods are hampered by respiratory motion, e.g., in the lower lobes. We present an image-guided approach that considers respiratory motion and can localize instruments. We developed a rigid chest marker containing steel balls visible in X-ray images and a pattern for passive tracking with an optical camera system. An experimental setup to evaluate stereoscopic localization and to mimic chest motion was established in our interventional suite. The marker motion was recorded, and X-ray images were acquired from different angles using a standard C-arm. All coordinates were expressed with respect to the stationary tracking camera. The feasibility of motion-compensated stereoscopic localization was assessed. The orientation of the C-arm could be established with a mean error of less than 1°. Triangulation based on two different X-ray images from different angles resulted in a mean error of 1.8 (±0.7) mm. A similar result was obtained when the marker was moved between X-ray acquisitions, and the mean error was 1.6 (±1.4) mm. The latencies were approximately 80 and 380 ms for tracking camera and X-ray imaging, respectively. Stereoscopic localization of a moving target was feasible. The system presents a flexible alternative for precise stereoscopic localization of a bronchoscope or instruments using a standard C-arm. We demonstrated the ability to track multiple moving markers and to compensate for respiratory motion.

1552 DEVELOPMENT OF A NAVIGATION SYSTEM USING A MAGNETIC TRACKING SYSTEM FOR URETEROSCOPY

You have accessJournal of UrologyStone Disease: New Technology1 Apr 20131552 DEVELOPMENT OF A NAVIGATION SYSTEM USING A MAGNETIC TRACKING SYSTEM FOR URETEROSCOPY Kenji Yoshida, Gen Kawa, Hidefumi Kinoshita, and Tadashi Matsuda Kenji YoshidaKenji Yoshida Osaka, Japan More articles by this author , Gen KawaGen Kawa Osaka, Japan More articles by this author , Hidefumi KinoshitaHidefumi Kinoshita Osaka, Japan More articles by this author , and Tadashi MatsudaTadashi Matsuda Osaka, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3062AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current flexible ureteroscopes have smaller outer diameters and larger working channels. These improvements have allowed access to the entire intrarenal correcting system and also permitted urologists to efficiently treat upper urinary tract pathology. However, controlling a flexible ureteroscope require a certain level of expertise and it takes a lot of times and efforts to acquire the adequate skills. Novice operators sometimes lose the spatial orientation during examination in patients with complicated pyelocaliceal shapes. Therefore the perioperative navigation system would be useful for ureteroscopic treatment in upper urinary tract. In this study, we introduced our experimental model of ureteroscopic navigation system. METHODS Our navigation system uses a magnetic tracking system to detect the position of the sensor cord tip. Magnetic field generator detects the position and orientation of sensors within a defined dome-shaped volume. Cord with sensors passes through the endoscopic channel and position of tip and 8 cm from the tip were tracked in real time. The phantom model and 3-D images of the pyelocaliceal system were created from DICOM CT data obtained from a specific patient. The plaster phantom had an inner cavity to allow use of an endoscope and was fixed to an acrylic board in the magnetic field. The instrument tip position in the magnetic field was detected by calibration. To align the position of the pyelocaliceal phantom to 3D images, the corner of the acrylic board was adjusted using fiducial landmarks. RESULTS When passing an endoscope into the phantom, the tip position was displayed in 3D images. 3D images were displayed on the secondary monitor positioned next to the main monitor. Our navigation system accurately displayed the position of the ureteroscope in 3D images of the inside of the phantom (Figure). CONCLUSIONS Our navigation system could help to access to all calices of collecting system. It would increase the efficiency of stone removal and the chances of finding upper tract urothelial lesions. This system can also be used as a training system for novice endoscopists to acquire fundamental skills and has a possibility to reduce fluoroscopy time. To use our system clinically, the sensor must be built into the endoscope shaft and this is an area of future research. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e637 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenji Yoshida Osaka, Japan More articles by this author Gen Kawa Osaka, Japan More articles by this author Hidefumi Kinoshita Osaka, Japan More articles by this author Tadashi Matsuda Osaka, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1104 THE HISTORY AND EVOLUTION OF PERCUTANEOUS NEPHROLITHOTOMY

You have accessJournal of UrologyHistory of Urology Forum1 Apr 20131104 THE HISTORY AND EVOLUTION OF PERCUTANEOUS NEPHROLITHOTOMY Sutchin R Patel, and Stephen Y Nakada Sutchin R PatelSutchin R Patel Madison, WI More articles by this author , and Stephen Y NakadaStephen Y Nakada Madison, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.696AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Serendipity, innovative physicians, evolving techniques for renal access and improvements in equipment and radiology led to the evolution of percutaneous nephrolithotomy (PCNL). METHODS We searched urology texts and the current literature for sources pertaining to the history and development of PCNL. RESULTS In 1941, Rupel and Brown performed the first nephroscopy when a rigid cystoscope was passed through a nephrostomy tract and residual stones were removed following open surgery. Well known urologist Willard Goodwin, in 1955, while trying to perform a renal arteriogram, placed a needle into the collecting system of a hydronephrotic kidney and performed the first antegrade nephrostogram. He left a tube to drain the kidney, thereby placing the first nephrostomy tube By 1976, Fernström and Johansson were the first to describe a technique for extracting renal calculi through a percutaneous nephrostomy under radiological control. In 1978, Arthur Smith would describe the first antegrade stent placement when he introduced a Gibbons stent through a percutaneous nephrostomy in a patient with a reimplanted ureter with a urine leak to allow the urinary leak to seal. Dr. Smith would coin the term “endo-urology” to describe closed, controlled manipulation of the genitourinary tract. His collaboration with Kurt Amplatz, an interventional radiologist and medical inventor, would lead to numerous innovations which would further advance PCNL. In the 1980s the process of renal access and tract dilation was improved upon and the use of a rigid cystoscope was replaced by offset nephroscopes with a large straight working channel. Francisco Sampaio's casts of the renal collecting system and vascular anatomy in human cadavers would further aid urologists in obtaining access to the collecting system while minimizing the risk of bleeding in the 1990s. The introduction of fiber optics led to the utilization of flexible nephroscopy to aid in less invasive stone clearance, while radiographic innovations, from improvements in fluoroscopy to the use of pre-operative computed tomography, would further aid in renal access. The development of various lithotripsy devices (ultrasonic, pneumatic, combined) and the introduction of the holmium laser improved the efficacy of stone fragmentation and clearance. The increased clinical experience and utilization of PCNL would further lead to the characterization of stone free rates and complications for the procedure. CONCLUSIONS Serendipity, innovations in renal access, optics, radiology and improvements in lithotripsy all contributed to the modern day PCNL. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e452 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sutchin R Patel Madison, WI More articles by this author Stephen Y Nakada Madison, WI More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

The Role of Direct Peroral Cholangioscopy Using an Ultraslim Endoscope for Biliary Lesions: Indications, Limitations, and Complications

Advantages of direct peroral cholangioscopy (POC) using an ultraslim endoscope include use of conventional endoscopy equipment, operation by a single endoscopist, and superior image quality of the biliary tree with easy application of enhanced endoscopy and a large working channel. The major diagnostic indications of this system are an evaluation of biliary strictures, filling defects, or unclear findings on cholangiogram or other imaging studies. Therapeutic application using a direct POC system can be broadened by a larger working channel. However, direct POC is difficult to apply in patients with a narrow diameter bile duct, far distal common bile duct lesion, or failed anchoring of the scope with accessories. An air embolism is a rare complication of direct POC but can be a fatal problem. Cholangitis can also occur during or after the procedure. Use of a CO2 system instead of room air during the POC procedure and administration of antibiotics before and after the procedure are strongly recommended. Continuous development of specialized endoscopes and accessories is expected to facilitate the diagnostic and therapeutic roles of direct POC.

The advantages of balloon assistance in endovascular embolization of spinal dural arteriovenous fistulas

Endovascular embolization is accepted as an alternative to surgical management of spinal dural arteriovenous fistulas (DAVF) in most patients; however, when the feeder vessel arises from the trunk vessel with an acutely angled origin, microcatheter navigation may be difficult, hazardous, and sometimes impossible. We propose a technique that eases microguidewire engagement and microcatheterization of arteries that arise at very acute angles with the assistance of a parallel compliant balloon that acts as supporter, guider, and protector. This technique was successfully applied in three consecutive patients with spinal DAVF with unfavorable vascular anatomy that limited selective microcatheterization. The balloon supports and guides the microguidewire along the feeder (supportive role). The balloon can then be placed at the origin of the feeder vessel and inflated during embolization to prevent liquid agent reflux (protective role). Use of this technique as a first option reduces procedure time and radiation exposure. A limiting factor is the need for a relatively large working channel to allow the combined use of a balloon and a microcatheter.

Endoscopic Biliary Access

Endoscopic Biliary Access