Correspondence Address: Giuseppe Giusti Department of Urology, University of Cagliari, Cagliari Italy
Source of Support: None, Conflict of Interest: None
Fluid leakage from the Ampltz sheath during flexible nephroscopy after PCNL prevents dilatation of the pelvi-calyceal system and adequate visualization. This video demonstrates a simple technique to prevent such leakage.
How to cite this article: Giusti G, De Lisa A. A smart trick to perform a flexible renoscopy during percutaneous nephrolithotripsy. Indian J Urol 2018;34:233-4
While performing percutaneous nephrolithotripsy (PCNL), it is frequently necessary to use a flexible endoscope to reach the stones that are not accessible using a rigid scope. Additionaly, it is usedto confirm stone-free status at the end of the procedure. We demonstrate a simple procedure to avoid a common problem related to switching from the rigid nephroscope to the flexible one where the space between the instrument and the operative sheath gives rise to fluid leak that makes distension of renal pelvis and calices very difficult. Without adequate fluid distension, a correct vision of the caliceal cavities is impossible.
Materials and Methods
The procedure requires a surgical glove and a silk surgical thread. A finger of the glove is cut and used to close the outer end of the Amplatz sheath. The surgical thread is used to fix the finger glove to the sheath. Through a small incision on the glove, it is possible to introduce the flexible endoscope. The glove acts like a gasket preventing the fluid leakage from the sheath [Figure 1] for [Video]. The glove can be pulled-up from one end to allow egress of fluid, if required. Overpressure never occurs because of the elasticity and the low sealing property of the gasket.
Figure 1: The glove gasket in action during flexible nephroscopy
This maneuver was used in 506 out of 632 PCNLs performed at our centre since 2010. The analysis of our data shows that the incidence of complications was not significantly different before the introduction of this technique (9.45% Grade I; 4.01% Grade II sec. Clavien-Dindo) and after it (8.1% Grade I; 3.6% Grade II sec. Clavien-Dindo). The maneuver proposed is easy to perform, always possible, and does not give rise to any complication. The positioning of the finger glove requires an extra time of about 1 min, which is well compensated by a better view of the renal cavities.