Category: Stones: PCNL

VS2-7 - Calyx Puncture Learning by “Light and Shadows” Without Radiation Exposure Using a Smartphone Torch-App

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

In percutaneous renal surgery, we use the monoplane fluoroscopy calyx puncturing technique. We present a video of a latex glove model using the principle of light and shadows, for initial learning of percutaneous calyx puncture, without radiation exposure. The technique of puncture is performed without rotating the light source. The smatphone torch Application is used as the source of light.


Methods :

a Foam box is used. A latex glove is inflated with air, and it is inserted in the slit in the box’s side, thus, the fingers are horizontal. The Torch application of a smart-phone is lighted. The phone is inserted below the glove. The box is covered with a paper. The shadows of the fingers and the puncture needle are projected on the paper. The puncture needle is used through the lateral side opposite the glove. The beam of light is perpendicular to the tract, so it gives orientation in the frontal plan. The needle is aligned with the glove’s tip in the frontal plan, then it is moved from down to up in the transversal plan, with little thrusting movements, until the finger moves. The fingers’ tips are used as calyxes; puncture is to push the finger’s tip in the middle until it is invaginated.


The gloves’ fingers can be shortened using ligation in the middle, and then the glove is inversed inside out. Thus, the shape will be similar to the shape of a hydronephrotic kidney.


Results :

The torch-app-model is simple and rapid to set up. It is economical, by using very cheap and widely available material. It can be used in classrooms and workshops without the risks of radiation exposure, and there is no limit of training time. The technique of puncture is performed without rotating the light source, which is similar to our technique of puncture without rotating the C-arm. It allows beginners the initial use of the puncture needle and its orientation in the space.


However, dilation and Amplatz sheath insertion are impossible. There is a limitation in terms of "tissue feeling" and for anatomic relations. Ultrasound-imaging guidance cannot be used.


Conclusions :

The technique of puncture is performed without rotating the light source, which is similar to our technique of puncture without rotating the C-arm. The smartphone-torch-application model allows beginners the initial use of the puncture needle and its orientation in the space. It can be used in classrooms and workshops without the risks of radiation exposure, and there is no limit of training time. However, further studies are needed for validation.

Mohammed Lezrek

Professor of Urology
1- Department of Urology, Military Hospital Moulay Ismail, Meknes, Morocco. 2- Department of Urology, Al Ghassani Hospital, Fes, Morocco.
Meknes, Meknes-Tafilalet, Morocco

Dr. Mohammed Lezrek, M.D, Professor of Urology, Faculty of Medicine, University Mohamed V, Rabat Morocco. Certified Moroccan board of Urology 1999. Fellowship-Post-Residency in the Department of urology and Transplantation Edouard Herriot hospital, Lyon, France May 2001- May 2002. AFSA diploma of urology, at the university Claude Bernard Lyon, France May 2001-December 2001.
Co-chairman of the department of urology in the military Hospital Moulay Ismail, Meknes, Morocco, since 1996, and then Chairman from March 2009 to March 2011. Voluntary work Promoting endourology and minimally invasive surgery in Morocco coaching young urologist in Morocco since February 2011 to present. Charmain of the Symposium of Affordable New technologies in Urology (SANTU) since 2017.
Member of AMU (Moroccan Association of urology) since 1996, EAU 2009, SIU 2011, and Endourological society 2012.
Associate Editor and Editorial Review Board, Clinical Urology (J of AMU), since 2009.
Reviewer in the Journal of Endourology. Meeting Scientific comity: AMU meetings since 2007; SIU: 2010, 2012, 2014-2016.
Awards and Achievements: - Best video Award of AMU Congress Skhirat 2016.
- Merit Award of AMU Rabat 2015. The SIU’s Best Video Award: First Prize during the 34th Congress of the SIU Glasgow 2014. The Best Video Award: First Place, during the 3rd SANTU organized SIU Glasgow 2014. SIU’s Best video Award: runner-up video, at the 33rd Congress SIU Vancouver 2013. Best Moderated Poster Award at 2nd Symposium on SANTU during SIU Vancouver 2013.
Presented multiple videos, Moderated Posters, Unmoderated Posters, presentations, invited talk, in national and international meetings.
More than 120 videos of tips and trick of Endourology in Youtube channel:
http://www.youtube.com/user/lezrekmohamed

Prabhakar Mithal

Hicham Tazi

fES, Fes-Boulemane, Morocco

Imad Ziouiou

Noueredine Bentani

Oussama El Yazami

Mostafa Elmcherqui

Casablanca, Grand Casablanca, Morocco

Mohammed Alami

Meknes, Meknes-Tafilalet, Morocco

Abdelghani Ammani

Meknes, Meknes-Tafilalet, Morocco