Operative nephroscopy with fiberoptic scope: preliminary report

Transforceps operative nephroscope

A new type of operative nephroscope has been developed that possesses the advantages of a fiberoptic scope but with good tactile sensation. The diameter of the scope is 2.3 mm. and its overall length is 770 mm., with a working length of 600 mm. The angle of the visual field is 70 degrees and its depth is 3 to 50 mm. The fiberscope is used in combination with forceps with hollow arms. The instrument is inserted through 1 of the arms of the forceps, while the other arm can be used for irrigation. The fiberscope may be fixed on a stand and, therefore, pyelolithotomy can be done in the conventional manner while the interior of the renal pelvis is observed. The instrument was used for pyelolithotomy in 26 patients with multiple renal stones and to examine the renal pelvis in 16 with drainage by nephrostomy or cutaneous ureterostomy. All stones were removed successfully in all but 1 patient in the former group.

Extended pyelolithotomy: the use of renal artery clamping and regional hypothermia

Extended pyelolithotomy is a technique applicable for removal of most staghorn, and large pelvic and caliceal calculi. Nephrotomy incisions can be avoided in many cases. The efficiency of extended pyelolithotomy in difficult cases can be improved by renal artery occlusion combined with regional renal hypothermia. Devascularization of the kidney produces softening of the renal substance, which facilitates stone removal. The operative method is described and 5 cases are presented.