Percutaneous stone removal: new approaches to access and imaging

Percutaneous Transhepatic Choledochoscopic Lithotomy (PTCSL) is Effective for the Treatment of Intrahepatic and Extrahepatic Choledocholithiasis

BACKGROUND

To explore percutaneous transhepatic choledochoscopic lithotomy (PTCSL) as a treatment for intrahepatic and extrahepatic choledocholithiasis.

PATIENT AND METHODS

A retrospective review of 67 patients with intrahepatic and extrahepatic choledocholithiasis treated by PTCSL from January 2014 to January 2019, including 36 males and 31 females, with an average age of 66 years. During the operation, the doctor established a channel through a 16-Fr Amplatz sheath and removed the stone in the channel with the aid of nephroscope. The clinical efficacy and complications of all patients were analyzed.

RESULTS

Sixty-seven patients (67/67, 100%) had their stones successfully removed in the first operation. Only 2 patients (2/67, 3.0%) developed mild reactive pleural effusion after the operation, and 1 patient (1/67, 1.5%) with cholangiocarcinoma after the operation. The incidence of severe bleeding during the operation was 0%.

CONCLUSION

PTCSL is a minimally invasive, simple, effective and easy to repeat procedure for use in the clinic. It is an effective surgical treatment and is worthy of clinical use.

[Navigation systems for the percutaneous access to the kidney]

BACKGROUND

Percutaneous access to the renal pelvis still remains the most difficult step before nephrolitholapaxy (PCNL). New imaging techniques, such as 3D imaging and various navigation instruments such as electromagnetic, sonographic, CT-controlled and marker-based/iPAD try to simplify this step and reduce complications.

OBJECTIVES

In this review, various new techniques for puncturing the renal collecting system are presented and their advantages and disadvantages are evaluated.

MATERIALS AND METHODS

A systematic literature search was carried out in MEDLINE, whereby only puncture techniques that have already been evaluated in clinical studies were included.

RESULTS

Five different navigation methods for puncturing the renal pelvis before PCNL were found.

CONCLUSION

Intraoperative navigation can be useful when puncturing the collecting system. The combination of ultrasound and fluoroscopy currently remains the gold standard. However, there is still a need for further, primarily clinical, prospective studies to determine which new imaging technology and navigation systems will prevail and thus facilitate the access route to the kidney, especially in the case of special anatomical conditions.

New Imaging Techniques in the Management of Stone Disease

Recent advances in computed tomography, X-ray-based imaging, and ultrasonography have improved the accuracy of urinary stone detection and differentiation of stone composition while minimizing radiation exposure. Dual-energy computed tomography and digital tomosynthesis show promise in predicting mineral composition to optimize medical and surgical therapy. Electromagnetic tracking may enhance the use of ultrasonography to achieve percutaneous renal access for nephrolithotomy. This article reviews innovations in imaging technology in the contemporary management of urinary stone disease.