Mini-ECIRS in a Horseshoe kidney in Supine position

Case Record:

• Male patient, 69 years old, with no pathological history of interest, diagnosed of left staghorn lithiasis in a horseshoe kidney due to abdominal pain, scheduled for percutaneous renal surgery.

Clinical History:

•  69-year-old male with Staghorm stone in a Horseshoe kidney

Technique description:

• Endoscopic combined intrarenal Surgery (ECIRS) in Supine position with Endovision puncture(0-90 degrees tech) and High power Laser lithotripsy.

Procedure steps:

1. Positioning of the patient in GMSV position: Galdakao modified supine Valdivia position
2. Semi-rigid ureteroscopy: Inspection of the left ureter and entry of first guidewire into left renal pelvis.
3. Passage of double lumen catheter for double guidance in renal pelvis
4.  Flexible ureteroscopy with Lithovue threaded through ureteral guidewire to the renal pelvis, entering the renal pelvis.
5. Retrograde pyelography with contrast through Lithovue to delimit the entire renal anatomy and select the calyx to puncture.
6. Percutaneous renal puncture with 0-90 degree technique and endovision.
7. Dilatation of the percutaneous renal tract with Amplatz 18F
8. 12F nephroscope and holmium lumenis p120 laser lithotripsy
9. Fragment removal with nitinol basket zerotip
10. Combination of flexible ureteroscope and flexible cystoscope for stone free control of all renal cavities
11.  Placement of double j Tria

Trainings Objectives:

1. Endovision with 0-90 degrees kidney puncture technique
2.  Lithotripsy with High Power Holmium Laser