Catalina Tessi1, María Tatiana Szklarz2, Felicitas López Imizcoz2, Javier Ruiz2, Santiago Weller2, Cristian Sager2, Pablo Omar Agustin Schiavo3, Pablo Horacio Lechuga4, Antonio Luna4, Juan Pablo Corbetta2. 1. Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina. Electronic address: catalinatessi89@gmail.com. 2. Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina. 3. Telehealth Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina. Electronic address: pabloschiavo10@gmail.com. 4. Telehealth Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina.
Abstract
INTRODUCTION: Simultaneous bilateral endoscopic surgery (SBES) is the performance of a percutaneous nephrolithotomy (PCNL) on one side and a retrograde intrarenal surgery (RIRS) on the other kidney simultaneously. OBJECTIVE: Our aim is to report through a video the surgical technique and the step-by-step details of a SBES performed in a pediatric patient. PATIENTS AND METHODS: A 12-year-old male patient with bilateral upper tract urolithiasis. RESULTS: Supine PCNL is performed in Galdakao-modified Valdivia position. Ureteroscopic surgeon performs retrograde pyelography on PCNL kidney. Percutaneous access under fluoroscopic guidance trough the lower calyx and dilated with Amplatz dilators to 17.5 Fr. Storz® 17.5 MIP Nephroscope is introduced and fragmentation with pneumatic lithotripter starts. On the other kidney, after introduction of ureteral sheet 12/14 Fr and digital flexible ureteroscope Flex Xc ® 9.5Fr, pulverization of the stone starts with Laser Holmium YAG (Oddysey®). Surgeons work simultaneously and share fluoro-scopic c-arm. CONCLUSION: SBES can be reproduced in children. Proper planification and preparation of the involved team and OR set up are essential. Further prospective randomized studies are needed to establish safety and efficacy of SBES in pediatric patients.
INTRODUCTION: Simultaneous bilateral endoscopic surgery (SBES) is the performance of a percutaneous nephrolithotomy (PCNL) on one side and a retrograde intrarenal surgery (RIRS) on the other kidney simultaneously. OBJECTIVE: Our aim is to report through a video the surgical technique and the step-by-step details of a SBES performed in a pediatric patient. PATIENTS AND METHODS: A 12-year-old male patient with bilateral upper tract urolithiasis. RESULTS: Supine PCNL is performed in Galdakao-modified Valdivia position. Ureteroscopic surgeon performs retrograde pyelography on PCNL kidney. Percutaneous access under fluoroscopic guidance trough the lower calyx and dilated with Amplatz dilators to 17.5 Fr. Storz® 17.5 MIP Nephroscope is introduced and fragmentation with pneumatic lithotripter starts. On the other kidney, after introduction of ureteral sheet 12/14 Fr and digital flexible ureteroscope Flex Xc ® 9.5Fr, pulverization of the stone starts with Laser Holmium YAG (Oddysey®). Surgeons work simultaneously and share fluoro-scopic c-arm. CONCLUSION: SBES can be reproduced in children. Proper planification and preparation of the involved team and OR set up are essential. Further prospective randomized studies are needed to establish safety and efficacy of SBES in pediatric patients.