Presentation Authors: Kamaljot Kaler*, Calgary, Canada, Vinay Cooper, Mitchell O'Leary, Zachary Valley, Thomas Lee, Roshan Patel, Jaime Landman, Ralph Clayman, Orange, CA
Introduction: Laser Endoscopic X-ray-guided Intrarenal Tract (LEXIT) is a recently described retrograde access technique for creating a percutaneous nephrostomy using the Holmium laser. Herein, we compared the feasibility and safety of LEXIT with the retrograde Lawson rocket wire technique and standard antegrade 18-gauge nephrostomy needle access in a porcine kidney.
Methods: Seven pigs underwent nephrostomy accesses with simultaneous laparoscopic vision at 5 mmHg pressure. For each kidney, the aforementioned three access methods were randomized. The following data were collected: access time, bleeding severity (Scale: 1=no bleeding â€“ 10=severe bleeding), bleeding duration, calyceal point of entry, and surgeon comfort with the technique (Scale: 1=very easy - 10=very difficult). Analysis of variance was performed to examine the differences among the 3 access methods.
Results: A total of 73 accesses were completed with an average of five nephrostomy tracts per kidney. The LEXIT access time was significantly faster than the nephrostomy needle or Lawson puncture wire (8.4, 63, 21 seconds (s), respectively, p < 0.002). Bleeding intensity and duration were significantly lower with the Lawson wire (0.0, 0.0 s), versus LEXIT (2.1, 58.6 s) and the nephrostomy needle (3.4, 110.5 s) (Table 1). LEXIT was rated as in the easiest method for acquiring access within all calyces: upper pole (p=0.003), interpolar calyces (p < 0.001), and lower pole (p < 0.006) (Table 2).
Conclusions: In the in vivo porcine kidney, endoscopic-guided retrograde holmium Laser Endoscopic X-ray-guided Intrarenal Tract (LEXIT) creation provided the fastest access times and greatest ease of access to the upper and interpolar calyces. Bleeding during LEXIT was significantly less than standard antegrade nephrostomy needle access.