Capsule to Calculus Optical Dissection for Tract Creation During Difficult Percutaneous Nephrolithotomy

Abstract Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) remains the mainstay modality for large burden kidney stone management. Access to the pelvicaliceal system is the key step for success of PCNL for complete stone clearance and minimal complication. However, many times in cases of impacted stones, staghorn calculi, nondilated pelvicaliceal systems, or thin renal cortex, it becomes difficult to establish a tract into the calix after initial puncture and the procedure may have to be abandoned. In this video, we present our technique of intrarenal dissection to salvage difficult cases using standard PCNL instruments. Methods: We performed this novel technique in nine patients with staghorn stones or impacted caliceal stones. As per the standard PCNL protocol, fluoroscopic-guided puncture and guidewire placement into the collecting system are performed; then, the tract is dilated with a balloon or Amplatz Dilators and a sheath is placed. A nephroscope is passed under direct vision and an...