Abstract
To describe a concept of ideal ‘puncture zone’ as against any single ideal ‘puncture tract’ for percutaneous nephro-lithotomy (PCNL) and present our results. Through this narrative, we aim to reduce the gaps in inter-understanding of an erstwhile description of ideal tract and real-life puncture making. The puncture zone principle was applied for our novel puncture making technique during PCNL. The largest imaginary cone that can fit into a respective calyx, with its tip in the pelvis defines the ‘puncture zone’ for that calyx. This concept allows fine-tuning of the ideal puncture tract based upon the desired corresponding manipulation zone and also shifts the focus of puncture making to infundibulum anatomy from the tip of calyx. The surgical technique and retrospective review of 136 cases done between 2015 and 2021 using this concept are presented. Primary outcome included stone-free rate, pseudo-aneurysm and blood transfusion at 3 months of follow-up. 33 cases had multiple (> 3) stones, 21 only calyceal/infundibular stones, eight partial staghorn and 12 were complete staghorn stones. Mean stone size was 29 ± 15 (Range: 5–53) mm. Complete clearance was achieved in 127 cases, four of which required two tracts. Blood transfusion was required in one case. No pseudo-aneurysms were encountered. The puncture zone concept has provided good results in our hands. It may help easier understanding of PCN puncture making and provides a background for reconciliation between description of an ideal tract and practical puncturing techniques used by different surgeons.
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The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
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Study conception and design were performed by RN. Material preparation, data collection and analysis were performed by RN, AS and NA. The first draft of the manuscript was written by RN, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Video 1. The puncture zone concept for percutaneous nephro-lithotomy and our results with this technique (MP4 427197 KB)
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Nayyar, R., Sachan, A., Aggarwal, N. et al. Anatomical approach to PCNL: concept of ideal puncture zone in a 3D perspective. Urolithiasis 51, 99 (2023). https://doi.org/10.1007/s00240-023-01477-9
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DOI: https://doi.org/10.1007/s00240-023-01477-9