The possibility of access to the kidneys from posterior axillary line in supine position for percutaneous nephrolithotomy
Please cite this article as: Tabibi A, Kashi AH, Mirjalili SAM, Mahmoudnejad N, Kashani P, Salavatipour B, Soltani MH. The possibility of access to the kidneys from posterior axillary line in supine position for percutaneous nephrolithotomy. Novel Biomed 2013;1(2):43-47.
Objectives: To evaluate the possibility of access to the kidneys from posterior axillary line (PAL) in supine position for percutaneous nephrolithotomy.
Materials and Methods: 102 consecutive patients who were candidated for abdominal CT scan, enrolled in this study. In cases of impossible access, the point on the posterior surface of body which permitted safe access was determined and the percent of movement toward body midline (relative to PAL) was calculated (M.PER).
Results: Percutaneous access was simulated from upper and middle calyces of the kidney in 13% and 75% of cases, respectively. Access to the lower region was possible in 90% of right and 79% of left lower calyces, respectively (p=0.03). In cases with impossible access from PAL, the M.PER for a safe access was 46-47% for upper region and 34- 38% for middle and lower calyces of the kidney (P = 0.0001).
Conclusions: Access to upper calyces from PAL was limited in some cases regarding to the presence of solid organs. Presence of colon made access impossible in the lower right and left calyces in about 10% and 20% of cases, respectively. In upper region, more deviation toward midline was necessary to establish a safe access compared with middle and lower calyces.
Basiri A, Mohammadi M, Hosseini SR , Moradi Vadjargah A, Shakhssalim N, Kashi AH, et al. X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance. World J Urol. 2010 Apr; 28(2):239-44.
Rana AM, Bhojwani JP, Junejo NN, Das Bhagia S. Tubeless PCNL with patient in supine position: procedure for all seasons?-- with comprehensive technique. Urology. 2008 Apr; 71(4):581-5.
Gerspach JM, Bellman GC, Stoller ML, Fugelso P. Conservative management of colon injury following percutaneous renal surgery. Urology. 1997 Jun; 49(6):831-6.
Hadar H, Gadoth N. Positional relations of colon and kidney determined by perirenal fat. AJR Am J Roentgenol. 1984 Oct; 143(4):773-6.
Hopper KD, Sherman JL, Williams MD, Ghaed N. The variable anteroposterior position of the retroperitoneal colon to the kidneys. The variable anteroposterior position of the retroperitoneal colon to
the kidneys. Invest Radiol. 1987 Apr; 22(4):298-302.
Maillet PJ, Dulac JP, Barth X, Pelle-Francoz D, Peix JL, Bobin JY. Colonic perforations during interventional urinary radiology. J Radiol. 1986 Mar; 67(3):225-9.
Noor Buchholz NP. Colon perforation after percutaneous nephrolithotomy revisited. Urol Int. 2004; 72(1):88-90.
Prassopoulos P, Gourtsoyiannis N, Cavouras D, Pantelidis N. A study of the variation of colonic positioning in the pararenal space as shown by computed tomography. Eur J Radiol. 1990 Jan-Feb; 10(1):44-7.
Rodrigues Netto N Jr, Lemos GC, Fiuza JL. Colon perforation following percutaneous nephrolithotomy. Urology. 1988 Sep; 32(3):223-4.
Sherman JL, Hopper KD, Greene AJ, Johns TT. The retrorenal colon on computed tomography: a normal variant. J Comput Assist Tomogr. 1985 Mar-Apr; 9(2):339-41.
Unal B, Kara S, Aktaş A, Bilgili Y. Anatomic variations of the colon detected on abdominal CT scans. Tani Girisim Radyol. 2004 Dec; 10(4):304-8.
Vallancien G, Capdeville R, Veillon B, Charton M, Brisset JM. Colonic perforation during percutaneous nephrolithotomy. J Urol. 1985 Dec; 134(6):1185-7.
Chan R, Li DK. An extreme case of retrorenal colon. AJR Am J Roentgenol. 2006 Oct; 187(4):W438.
Lojanapiwat B, Prasopsuk S. Upper-pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. J Endourol. 2006 Jul; 20(7):491-4.
Munver R, Delvecchio FC, Newman GE, Preminger GM. Critical analysis of supracostal access for percutaneous renal surgery. J Urol. 2001 Oct; 166(4):1242-6.
Shaban A, Kodera A, El Ghoneimy MN, Orban TZ, Mursi K, Hegazy A. Safety and efficacy of supracostal access in percutaneous renal surgery. J Endourol. 2008 Jan; 22(1):29-34.
Tuttle DN, Yeh BM, Meng MV, Breiman RS, Stoller ML, Coakley FV. Risk of injury to adjacent organs with lower-pole fluoroscopically guided percutaneous nephrostomy: evaluation with prone, supine, and multiplanar reformatted CT. J Vasc Interv Radiol. 2005 Nov;16(11):1489-92.
LeRoy AJ, Williams HJ Jr, Bender CE, Segura JW, Patterson DE, Benson RC. Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology. 1985 Apr; 155(1):83-5.
Chalasani V, Bissoon D, Bhuvanagir AK, Mizzi A, Dunn IB. Should PCNL patients have a CT in the prone position preoperatively? Can J Urol. 2010 Apr; 17(2):5082-6.