Modified technique of percutaneous cystolithotripsy using a new instrument--combined single-step trocar-dilator with self-retaining adjustable access sheath.

摘要

OBJECTIVES: To evaluate a new instrument and technique for access that overcomes the difficulties with percutaneous cystolithotripsy (PCCL). PCCL is a safe and established minimally invasive surgical option for large vesical calculi. It is commonly performed using a guidewire, serial dilation, and an Amplatz sheath. However, this technique has its shortcomings, including lengthy dilation, the cost of the disposable instruments (eg, guidewire, Amplatz), fluoroscopic/cystoscopic guidance, and the need for a surgical assistant. METHODS: The present prospective study was performed during a 6-year period. A total of 140 patients with a vesical calculus underwent PCCL. The modified technique using the new instrument was used for access, followed by primary closure of the stab wound. The operative time, length of hospitalization, complications, need for accessories, surgical assistant use, cosmesis, and cost were evaluated. RESULTS: Of the 140 patients, 100 were adults and 40 were children. The mean stone size was 4.15 cm. The modified PCCL technique using the newly designed combined single-step safety trocar-dilator with self-retaining adjustable access sheath resulted in a shorter operative time (mean 29.4 minutes), lower analgesic requirements, shorter hospitalization (2.28 days), lower cost, fewer complications, and better cosmesis. CONCLUSIONS: Our results have shown that this PCCL technique using the new trocar access system followed by primary wound closure is safe, technically easy, and cost-effective. It overcomes the shortcomings of the currently practiced methods, including lengthy dilation, cost of disposable instruments, the need for fluoroscopy/endoscopy, and the need for a surgical assistant. It also resulted in a decreased hospital stay and better cosmesis.