Percutaneous Renal Surgery Indications
The indications for percutaneous renal surgery include large/complex
stones, infectious stones and ablation of renal masses. The main
advantage of percutaneous renal access over ureteroscopy is that it
allows the introduction of a much larger caliber scope providing larger
instruments to be introduced. In limited circumstances transitional cell
carcinoma of the kidney may be treated using this technique. In addition
using ultrasound and CT guided imaging ablative technologies can be
introduced into the kidney.
Procedure
Using radiographic guidance a small needle is placed through the back
into the kidney. With this needle a tract is created which allows
placement of a trocar (tube) directly into the kidney's collecting
system. Once the trocar is in place a nephroscope and instruments are
introduced into the kidney. A nephrostomy tube is placed at the end of
the procedure and is usually removed prior to discharge.
When performing ablative procedures only 1 or 2 needles are introduced.
These needle deliver can either lethally freeze or heat up and destroy
the tumor and surrounding tissue.
Results
Percutaneous renal surgery is an excellent minimally invasive technique
for accessing the kidneys collecting system. Most often it is employed
to treat large and/or complex stones. Success rates are excellent;
complications remain low but are greater in general than retrograde
endoscopy (ureteroscopy). As a means to treat UPJ obstruction success
rates are similar to the ureteroscopic approach.
Percutaneous renal and prostate ablative procedures are relatively new
and our used in a select subset of patients at NYU Medical Center. In
addition, when performing renal ablative procedures Dr. Stifelman teams
up with Dr. Timothy Clark from interventional radiology to perform these
procedures.
Click here, to view video on
Transperitioneal Laparoscopic Cryoablation of Renal Mass.
Click here, to view video on Complex Laparoscopic Partial Nephrectomy.
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