Percutaneous Probe Research Articles

Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research.

Ultrasound-guided percutaneous cryoneurolysis provides analgesia using cold temperatures to reversibly ablate peripheral nerves. Cryoneurolysis probes pass a gas through a small internal annulus, rapidly lowering the pressure and temperature, forming an ice ball to envelope the target nerve. Analgesia is compromised if a nerve is inadequately frozen, and laboratory studies suggest that pain may be paradoxically induced with a magnitude and duration in proportion with the incomplete ablation. We therefore investigated the relative effects of various factors that may contribute to the size of the ice ball and the effective cryoneurolysis zone. A cryoprobe was inserted into a piece of meat, a gas was passed through for 2min, and the resulting ice ball width (cross-section) and length (axis parallel to the probe) were measured using ultrasound, with the temperature evaluated in nine concentric locations concurrently. The factor with the greatest influence on ice ball size was probe gauge: in all probe types, a change from 18 to 14 increased ice ball width, length, and volume by up to 70%, 113%, and 512% respectively, with minimum internal temperature decreasing as much as from -5 to -32°C. In contrast, alternating the type of meat (chicken, beef, pork) and the shape of the probe tip (straight, coudé) affected ice ball dimensions to a negligible degree. The ice ball dimensions and the zone of adequate temperature drop were not always correlated, and, even within a visualized ice ball, the temperature was often inadequate to induce Wallerian degeneration. Percutaneous probe design can significantly influence the effective cryoneurolysis zone; visualizing a nerve fully encompassed in an ice ball does not guarantee adequate treatment to induce the desired Wallerian degeneration because ice forms at temperatures between 0 and -20°C, whereas only temperatures below -20°C induce Wallerian degeneration. The correlation between temperatures in isolated pieces of meat and perfused human tissue remains unknown, and further research to evaluate these findings in situ appears highly warranted.

Clinical Experience of Use of Percutaneous Continuous Nervemonitoring in Robotic Bilateral Axillo-Breast Thyroid Surgery.

Introduction and ObjectiveThere is a need for a simplified technique for C-IONM in robotic surgery. The primary aim of this study was to describe our clinical experience with the use of percutaneous C-IONM in robotic bilateral axillary thyroid surgery.MethodsThis study prospectively enrolled 304 consecutive patients who underwent robotic thyroidectomy via the bilateral axillo-breast approach and standardized C-IONM via percutaneous probe stimulation.Results323 RLNs were analyzed. C-IONM with percutaneous probes was feasible in all cases. During this study, we did not record any cases of probe displacement, and no additional robotic maneuvers were required. The average stimulation intensity was 2 mA. There were no adverse local or systemic C-IONM side effects. The mean time required for probe positioning was 3 minutes. The EMG amplitude signal of 48 RLNs decreased significantly, < 50% from the original V1 signal. In these cases, the surgical procedure was modified.ConclusionThe proposed percutaneous C-IONM provides a simplification of the continuous monitoring procedure for robotics. The advantage of percutaneous C-IONM is that it does not require additional trocar space, repeated instrument changes, and unmodified cosmesis. To our knowledge, this is the first study on the application of percutaneous C-IONM in robotic thyroid surgery.

Image-guided percutaneous mechanical disc decompression for herniated discs: a technical note.

Interventional radiology plays a key role in the treatment of symptomatic herniations of intervertebral discs. Through image-guided techniques, it is possible to use minimally invasive procedures with a percutaneous approach that are usually proposed before classic surgery. Thanks to imaging guidance, it is possible to significantly increase accuracy and decrease complication rates. The pivotal principle of these mini-invasive techniques is to remove a small amount of volume of the nucleus of the intervertebral disc which results in a significant reduction in intradiscal pressure; allowing for a consequent reduction in compression of the nervous structures that generate spinal pain. However, it must be considered that this type of treatment is only addressed to contained disc herniations previously diagnosed with a suitable neuroimaging examination. There are different types of treatment using a variety of chemical, thermal or mechanical processes that result in partial removal of the nucleus pulposus. The purpose of this technical note is to illustrate mechanical disc decompression treatment via a percutaneous approach using the DISKOM device (DISKOM percutaneous discectomy probe, Biopsybell, Mirandola, Italy). Indications, complications and various methods of use are described in relation to the different levels of the spine to be treated. (www.actabiomedica.it).

Percutaneous probe stimulation for intraoperative neuromonitoring in total endoscopic thyroidectomy: A preliminary experience

The purpose of this study was to investigate the feasibility and value of using intraoperative neuromonitoring (IONM) performed via percutaneous probe stimulation during total endoscopic thyroidectomy. This study prospectively enrolled a series of 132 consecutive patients with 156 recurrent laryngeal nerves (RLNs) at risk who received total endoscopic thyroidectomy performed via bilateral breast approach using standardized IONM. The stimulation probe was introduced into the working space by percutaneous puncture. During lateral thyroid dissection, the proximal RLN was periodically stimulated to monitor adverse electromyography (EMG) changes. Preoperative and postoperative vocal cord mobility was routinely examined with laryngofiberoscopy. All IONMs were successfully performed via percutaneous probe stimulation with no morbidity or scarring in the neck. Twelve nerves (7.7%) showed significant changes in EMG (amplitude reduction, 50% to 90% from baseline EMG) during the lateral thyroid dissection. Compression near the inferior thyroid artery (70%) and traction near the Berry's ligament (30%) were the most common causative mechanisms, and modification of the surgical maneuver resulted in partial recovery of the EMG changes (amplitude reduction, 10% to 80% before wound closure). Of the 12 nerves with adverse EMG changes (final amplitude reduction, 65% to 80%), 8 nerves showed temporary (3 months or less) vocal cord palsy. No cases of permanent vocal cord palsy occurred in this series. Percutaneous probe stimulation is a simple, effective, and safe method of performing IONM in total endoscopic thyroidectomy when the operating space is limited. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1001-1007, 2017.

"Vascular lock" causing splenic perfusion defects during irreversible electroporation of a locally advanced pancreatic tumor.

There is little reported experience of irreversible electroporation (IRE) of locally advanced pancreatic tumors (LAP). In literature, few data reported complications. In particular vascular vasoconstriction miming splenic infarcts in humans has never been found. This report describes the onset of asymptomatic multiple little splenic perfusion defects after the treatment of a LAP localized in the boby-tail portion of the pancreas with the application of five percutaneous probes for IRE, in a 79 year-old man. Splenic artery was regularly patent but entirely trapped in the tumor. To the best of our knowledge, until now, no experience concerning percutaneous IRE of pancreatic cancer described that phenomenon. The cause could not be established with certainty and "vascular lock" may be a valid hypothesis. Additional studies are necessary to evaluate its frequency and its exact pathophysiological cause in humans.

ULTRASOUND GUIDED PROBE DEVICE AND METHOD OF USING SAME

The present invention is directed to devices and methods for use in ultrasound guiding of percutaneous probes during medical procedures. The ultrasound devices of the present invention include an ultrasound transducer. The devices can also include means and methods for imaging a virtual probe overlaying the sonogram formed by the ultrasound device such that a real time image of the probe approach to the target may be observed during and after probe placement.

Image Guided Percutaneous Probe Ablation for Renal Tumors in 65 Solitary Kidneys: Functional and Oncological Outcomes

We evaluated the oncological and functional outcomes of computerized tomography guided percutaneous cryotherapy or radio frequency ablation of kidney tumors in patients with a solitary kidney. We reviewed the medical charts of patients with a solitary kidney who underwent percutaneous probe ablation for renal masses at our institution from April 2002 through March 2010. Followup consisted of computerized tomography or magnetic resonance imaging 1 day postoperatively, at 3, 6 and 12 months, and annually thereafter. Serum creatinine and estimated glomerular filtration rate were used to measure renal function. The cryotherapy and radio frequency ablation groups were compared for demographics, the 2-year actuarial survival rate and renal function. Overall 65 patients were included in this retrospective analysis, of whom 29 (44.6%) underwent cryotherapy and 36 (55.4%) underwent radio frequency ablation. Median followup was 15.1 (IQR 4.4 to 32.9) and 38.8 months (13.8 to 50.7), respectively. The 2 groups were comparable in median age, body mass index, American Society of Anesthesiologists score, tumor size and preoperative estimated glomerular filtration rate. The 3 primary treatment failures, including 1 after cryotherapy and 2 after radio frequency ablation, were successfully re-treated with thermal ablation. There were 14 recurrences after radio frequency ablation and 3 after cryotherapy. Two-year actuarial overall, cancer specific, recurrence-free and metastasis-free survival rates for cryotherapy vs radio frequency ablation were 89% vs 93%, 100% vs 96%, 69% vs 58% and 86% vs 91%, respectively. For each group no significant decrease in renal functional parameters was found at the latest followup visit. Computerized tomography guided percutaneous probe ablation represents a safe treatment option in surgical patients at high risk with a solitary kidney. It provides low morbidity, acceptable short-term cancer control and minimal clinical impact on postoperative renal function.

1552 IN-VITRO ASSESSMENT OF TIP DYNAMICS IN A NEW PORTABLE BALLISTIC LITHOTRIPTER

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111552 IN-VITRO ASSESSMENT OF TIP DYNAMICS IN A NEW PORTABLE BALLISTIC LITHOTRIPTER Agnes J. Wang, Gavin McAlister, Jamie Gabriel, W. Neal Simmons, Michael E. Lipkin, Michael N. Ferrandino, Glenn M. Preminger, and Pei Zhong Agnes J. WangAgnes J. Wang Durham, NC More articles by this author , Gavin McAlisterGavin McAlister Durham, NC More articles by this author , Jamie GabrielJamie Gabriel Durham, NC More articles by this author , W. Neal SimmonsW. Neal Simmons Durham, NC More articles by this author , Michael E. LipkinMichael E. Lipkin Durham, NC More articles by this author , Michael N. FerrandinoMichael N. Ferrandino Durham, NC More articles by this author , Glenn M. PremingerGlenn M. Preminger Durham, NC More articles by this author , and Pei ZhongPei Zhong Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1560AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intracorporeal lithotriptor technology is moving towards devices that do not need a separate unit as an energy source. The benefits are in cost reduction as well as the portability and the “wireless” nature of the device. One such pneumatic device, the LMA Stonebreaker™, is powered by sterile CO2 cartridges. A new device under development is a battery-operated electrokinetic ballistic lithotripter in which probe velocity and displacement can be modified to suit clinical applications by changing the hardness of the probe guide. An in vitro model was designed to compare the tip speed and displacement characteristics of this new electrokinetic ballistic device. METHODS To determine tip velocity and displacement, the probe tip was aligned to partially occlude an expanded laser beam that was aimed at a high bandwidth photo detector. Displacement and velocity were measured for 1mm (ureteroscopic) and 2mm (percutaneous) probes with both hard and soft probe guides. The probe position was correlated with the voltage measurement from the photo detector. A digital oscilloscope was used to capture the time/displacement characteristics of the probe tip. Twenty-five displacement profiles were measured for each probe and support combination. Means and standard deviations were computed for all groups. RESULTS The tip displacement was significantly increased when a soft probe guide was used. The mean probe tip displacement increased 37% (0.31 ± 0.04mm increase) and 52% (0.42 ± 0.10mm increase) for ureteroscopic and percutaneous probes, respectively. Soft probes guides also increased the mean tip velocity by 15% (0.9 ± 0.2 m/s increase) and 14% (0.5 ± 0.2 m/s increase) for ureteroscopic and percutaneous probes, respectively. CONCLUSIONS The elasticity of the probe guide has a large impact on tip velocity and displacement characteristics of electrokinetic ballistic lithotrites. The ability to change tip dynamics may provide optimum performance over a wide range of stone types. High velocity and smaller displacement tip characteristics are suited for hard stones such as calcium oxalate monohydrate while lower velocity and larger tip displacement may be more useful on softer stones. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e623 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Agnes J. Wang Durham, NC More articles by this author Gavin McAlister Durham, NC More articles by this author Jamie Gabriel Durham, NC More articles by this author W. Neal Simmons Durham, NC More articles by this author Michael E. Lipkin Durham, NC More articles by this author Michael N. Ferrandino Durham, NC More articles by this author Glenn M. Preminger Durham, NC More articles by this author Pei Zhong Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

New Developments in Renal Focal Therapy

The aim of this study was to review recent advances and to provide future perspectives in renal focal therapy. Most relevant available data from current literature and reports from major urological meetings as well as clinical and experimental experience at our institution have been considered. Effective treatment of incidentally detected small renal masses continues to evolve. Major recent advances have been made toward three main directions: enhancing accuracy of probe positioning, improving ablative energy efficiency, and reducing treatment-related morbidity. Renal focal therapy can offer the advantage of combining a nephron-sparing surgery together with a minimally invasive approach. Technical refinements will include emerging clinical data for radiofrequency and cryoablation. Single-port access renal cryotherapy has been shown to be feasible and safe. Although in its infancy, natural orifice translumenal endoscopic surgery might represent a further step toward scarless surgery. Radiosurgery is under investigation and oncological outcomes are awaited to determine its role. Stereotactic surgical navigation and robotic needle placement would facilitate and increase the accuracy of percutaneous probe placement.

Third Prize: Synchronized Real-Time Ultrasonography and Three-Dimensional Computed Tomography Scan Navigation During Percutaneous Renal Cryoablation in a Porcine Model

To investigate the accuracy of percutaneous cryoablation for kidney tumors performed under combined real-time ultrasonography (US) and three-dimensional (3D) CT scan navigation in a porcine model. After percutaneously injecting 2 to 6 tumor mimic lesions in 11 pigs, a CT scan was performed and digital data were saved into a navigation system (Real-Time Virtual Sonography [RVS]) that allows 3D reconstruction and synchronization with real-time US images. The cryoprobe was guided percutaneously into the kidney tumor mimic, and ice ball formation was monitored continuously during cryoablation using the RVS system. Kidneys were harvested and sent for gross pathologic and histopathologic analysis at days 0, 15, and 30 postoperatively. Thirty-five renal tumor mimics were created and treated by percutaneous cryotherapy; tumor mimic locations were as follows: 16 tumors (46%) in the lower pole, 14 (40%) in the central region, and 5 (14%) in the upper pole. Eleven tumor mimics (31%) were intraparenchymal, and 24 (69%) subcapsular. The synchronization between the CT scan 3D reconstructed images and real-time US was successful in all cases. The mean tumor size was 2 cm (range, 1.2-4 cm). Mean cryonecrosis size was 3.3, 3.7, and 2.8 cm at days 0, 15, and 30, respectively. Three (8.5%) positive margins were found on the macroscopic and microscopic analysis. RVS imaging system synchronizing real-time US with preoperative CT scan is a feasible and safe technique for percutaneous probe ablation of kidney tumors.

The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth

Treatment decisions for renal malignancies depend largely on qualitative data, including a description of tumor anatomy and the experience of the treating surgeon. Currently characterization of renal tumor anatomical elements is descriptive and lacks standardization. Surgical decision making and data set comparisons would be significantly enhanced by a consistent, reproducible system that quantitates the pertinent characteristics of localized renal lesions. We have developed and propose a standardized nephrometry scoring system (R.E.N.A.L. Nephrometry Score) to quantify the anatomical characteristics of renal masses on computerized tomography/magnetic resonance imaging. The nephrometry score is based on 5 critical and reproducible anatomical features of solid renal masses. Of the 5 components 4 are scored on a 1, 2 or 3-point scale with the 5th indicating the anterior or posterior location of the mass relative to the coronal plane of the kidney. We applied the R.E.N.A.L. Nephrometry Score to 50 consecutive masses resected at Fox Chase Cancer Center. The R.E.N.A.L. Nephrometry Score consists of (R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of the tumor, (N)earness of tumor deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line. The suffix h (hilar) is assigned to tumors that abut the main renal artery or vein. The nephrometry scoring system accurately classified the complexity of 50 consecutive tumors undergoing excision at our institution. Standardized reporting of renal tumor size, location and depth is essential for decision making and effective comparisons. The R.E.N.A.L. Nephrometry Score is a reproducible standardized classification system that quantitates the salient anatomy of renal masses. This novel approach for the systematic characterization of renal tumors provides a tool for meaningful comparisons of renal masses in clinical practice and in the urological literature.

Thérapies par ultrasons focalisés

Many techniques of thermotherapy have emerged over the last several years in the field of oncology using different types of physical agents, including ultrasound. Only ultrasound can target deep seated lesions non-invasively without need for percutaneous probe insertion. Depending on their utilization, it is possible to select either thermal effects, in a continuous mode, at low temperature (allowing thermo-induced biological effects) or at high temperature (allowing thermoablation), or mechanical effects, in a pulsed mode, at low energy level (allowing biological effects) or at high energy levels (histotripsy). Thermoablation by focused ultrasound is now developing fast for applications in many organs. It gained a well defined role for the treatment of prostatic cancer and uterine leiomyoma but needs to be better evaluated in other organs such as the breast. Treatment of abdominal tumors must still be considered as experimental as long as problems related to acoustic interfaces (produced by ribs and gas) and movement correction are not resolved. Biological applications of focused ultrasound are currently being explored and have a great long term potential.

Techniques, Safety and Accuracy of Sampling of Renal Tumors by Fine Needle Aspiration and Core Biopsy

The incidence of renal cell carcinoma is increasing worldwide and there are new treatments for localized as well as metastatic tumors. The traditional role for percutaneous biopsy of renal masses has been limited, and so there is little general experience. There have been concerns about safety and accuracy. This review provides an update on the current techniques, indications and accuracy of needle biopsy of renal tumors. PubMed and MEDLINE were searched for English language reports of percutaneous needle core biopsy and fine needle aspiration of renal tumors that were published from 1977 to 2006. With the development of new biopsy techniques and wider experience with percutaneous probe ablation therapies the risk of tumor seeding appears negligible. Significant bleeding is unusual and almost always self-limiting. At centers with expertise needle core biopsy with or without fine needle aspiration appears to provide adequate specimens for an accurate diagnosis in more than 90% of renal masses. Percutaneous biopsy of renal masses appears to be safe and it carries minimal risk of tumor spread. Urologists should consider increasing the indications for renal biopsy of small renal masses that appear to be renal cell carcinoma, especially in elderly and unfit patients. With more experience and followup preoperative biopsy has the potential to decrease unnecessary treatment since up to a third of small renal masses are now reported to be benign at surgery. Percutaneous biopsy may also allow a better selection of renal tumors for active surveillance and minimally invasive ablative therapies. Finally, there is potential for stratifying initial therapy for metastatic renal cell carcinoma by histological subtype and in the future molecular characteristics.

Open Partial Nephrectomy for Tumor in a Solitary Kidney: Experience With 400 Cases

We present a series of 400 patients with tumor in a solitary kidney who underwent open surgical partial nephrectomy performed by a single surgeon (ACN) with a primary focus on postoperative long-term kidney function. A total of 400 patients with sporadic nonfamilial kidney tumors in a solitary kidney underwent open partial nephrectomy between 1980 and 2002. In 323 patients (81%) the contralateral kidney had been surgically removed, while the remaining 77 (19%) had a congenital solitary kidney. Renal insufficiency was present preoperatively in 184 patients (46%). Adverse risk factors for partial nephrectomy were present in a large percent of patients. Intraoperative and postoperative parameters were evaluated at a mean followup of 44 months. In the overall series 5 and 10-year cancer specific survival was 89% and 82%, respectively. Surgical complications occurred in 52 patients (13%), most commonly urinary leakage. Early postoperative renal function was achieved in 398 patients (99.5%). Only 2 patients required permanent dialysis postoperatively. Satisfactory long-term renal function was achieved in 382 patients (95.5%). A total of 18 patients had progressed to renal failure a mean of 3.6 years after surgery. Patient age, the amount of renal parenchyma resected, a congenitally absent or atrophic contralateral kidney and the time of contralateral nephrectomy were noted to be significantly associated with postoperative renal function. Open surgical partial nephrectomy can be safely performed in patients with tumor in a solitary kidney. Long-term cancer-free survival with the preservation of renal function can be reliably expected in most of these cases.

Laparoscopic Partial Nephrectomy in Solitary Kidney

We report our experience with LPN for tumor in a solitary kidney. Of 430 patients undergoing LPN since February 1999 at our institution 22 (5%) underwent LPN for tumor in a solitary kidney, as performed by a single surgeon. The laparoscopic technique that we used duplicated open principles, including hilar clamping, cold cut tumor excision and sutured renal reconstruction. Mean tumor size was 3.6 cm (range 1.4 to 8.3, median 3 cm), median blood loss was 200 cc (range 50 to 500), warm ischemia time was 29 minutes (range 14 to 55), total operative time was 3.3 hours (range 2.2 to 4.5) and hospital stay was 2.8 days (range 1.3 to 12). Two cases (9%) were electively converted to open surgery. Pathological findings confirmed renal cell carcinoma in 16 patients (73%) with negative surgical margins in all those with LPN. Major complications occurred in 3 patients (15%) and minor complications developed in 7 (32%). Median preoperative and postoperative serum creatinine (1.2 and 1.5 mg/dl) and estimated glomerular filtration rate (67.5 and 50 ml per minute per 1.73 m2) reflected a change of 33% and 27%, respectively, which appeared proportionate to the median amount of kidney parenchyma excised (23%). One patient (4.5%) required temporary hemodialysis. At a median followup of 2.5 years (range 0.5 to 4.5) cancer specific and overall survival was 100% and 91%, respectively. No patient with LPN had local or port site recurrence, or metastatic disease. LPN can be performed efficaciously and safely in select patients with tumor in a solitary kidney. To our knowledge we present the largest series in the literature. Advanced laparoscopic experience and expertise are necessary in this high risk population.

Intraoperative Monitoring of the Recurrent Laryngeal Nerve in 151 Consecutive Patients Undergoing Thyroid Surgery

Intraoperative Monitoring of the Recurrent Laryngeal Nerve in 151 Consecutive Patients Undergoing Thyroid Surgery

Percutaneous tissue ablation by radiofrequency thermal energy as a prelim to tumour ablation

Porcine hepatic tissue was ablated in vitro and in vivo with radiofrequency (RF) energy applied through various percutaneous probes. Ultrasound was used for guidance. The technique was assessed for potential use to ablate tumours percutaneously. Tissue ablation was performed in two porcine cadaver and six live piglet livers in various experiments, three RF generators with either bipolar gold probes, 18–22 gauge modified angiocath needles, titanium curved and spiral 0.018″ guidewires, three-pronged grabber baskets, and/or a thermistor (temperature-controlled) probe were used to induce the RF effect with simultaneous assessment by real-time ultrasound. Gross and microscopic analysis of the liver was undertaken after acute sacrifice of the animals. The hepatic tissue that surrounded the probe after RF energy application became increasingly echogenic sonographically. The size of the echogenic area on ultrasound corresponded to the size of the thermal lesion on gross and microscopic examination. Thermal lesions up to 2 cm were created. The size of the thermal lesion was proportional to the surface area of the probe, the shape of the probe, the generator power, and the length of time that the RF energy was applied. The thermistor probe permitted improved contact and control by preventing central charring, cavitation, and boiling of the tissue that occasionally was observed with other probes. Percutaneously applied radiofrequency energy using US-guidance and monitoring is a feasible method to ablate hepatic tissue.

Percutaneous Probe Reduction of Frontal Fractures of the Humeral Capitellum

Nine frontal fractures of the humeral capitellum treated by percutaneous probe reduction are reported. Most of the fractures were percutaneously reduced with a Steinmann pin inserted along the lateral border of the biceps tendon. To prevent redisplacement of the fragment, the elbow joint was first flexed more than 90 degrees with plaster immobilization for two weeks. The favorable results obtained with this method are due to reduced surgical trauma to local tissues and good reduction of the fracture. The percutaneous probe reduction should be considered for frontal fracture of the humeral capitellum before open reduction is performed.