ECIRS (Endoscopic Combined IntraRenal Surgery): From Background Actor to Main Character of the Endourological Treatment of Urolithiasis
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In this chapter the acronym ECIRS is explained as well as its history since the 1980s along with the rationale of combining the antegrade percutaneous and the retrograde endoscopic approaches with both rigid and flexible endoscopes for the treatment of large and/or complex urolithiasis. The optimal setup of the operating room, the preparation of the required instruments, devices and accessories, the favourite positioning of the patient (the Galdakao-modified supine Valdivia position, ideal from an anaesthesiologic point of view and optimally supporting the simultaneous retrograde access) and the step-by-step ECIRS procedure are reported. The role of retrograde flexible ureteroscopy before and during percutaneous nephrolithotripsy is discussed in detail with reference to its dual diagnostic and active intraoperative role. Why ECIRS should represent a consistent innovation in percutaneous surgery is fully explored with particular attention to the possibility to tailor in real time all the intraoperative choices on the patient, the urolithiasis and the anatomy of the collecting system, personalizing surgery.
KeywordsECIRS Endoscopic Combined IntraRenal Surgery Urolithiasis Percutaneous nephrolithotomy Retrograde flexible ureteroscopy Supine Galdakao-modified supine Valdivia position
Conflicts of Interest
Dr. C. M. Scoffone is consultant for Boston Scientific, Coloplast Porgés, Cook Medical, DBI, EMS, Olympus, Promed, Storz Medical; Dr. C. M. Cracco is tutor for Boston Scientific.
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