Investig Clin Urol.  2018 Sep;59(5):348-354. 10.4111/icu.2018.59.5.348.

Real-time simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: Washout mechanism and transport technique

• Jung HD
• Kim JC
• Ahn HK
• Kwon JH
• Han K
• Han WK
• Kim MD
• Lee JY

• KMID: 2419419
• DOI: http://doi.org/10.4111/icu.2018.59.5.348

Abstract

Endoscopic combined intrarenal surgery (ECIRS) with simultaneous retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) has been proposed as a new surgical treatment to overcome the disadvantage of RIRS and PCNL monotherapies in the treatment of renal stone. One of advantages of ECIRS is that it can increase stone-free rates in complex renal stone within single-session. Intermediate-supine position in real-time simultaneous ECIRS can prevent an anesthesiologic problem, and patient's burden is small even for long-term operation. Thus, we will share the experience and advantages of real-time simultaneous ECIRS and introduce techniques to increase the stone-free rate.

Keyword

Kidney; Nephrolithiasis; Ureteroscopy; Urinary calculi

MeSH Terms

Kidney
Nephrolithiasis
Nephrostomy, Percutaneous
Ureteroscopy
Urinary Calculi

Figure

• 

  Fig. 1 The endoscopic combined intrarenal surgery was performed with the patient under general anesthesia in the intermediate-supine (Galdakao-modified supine Valdivia) position. The patient was placed in the supine position with a 1-L saline bag below the ipsilateral flank.

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  Fig. 2 During real-time simultaneous endoscopic combined intrarenal surgery, nephroscope and flexible ureterorenoscope can take finger-touch to see each other. The appearance of the two endoscopes facing each other is similar to the fingertip in the movie E.T., and we named it finger-touch.

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  Fig. 3 With real-time simultaneous endoscopic combined intrarenal surgery, when the nephroscope is removed from the Amplantz sheath, fragmented stones exit through the sheath (arrow direction).

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