PCNL - Initial Puncture Prof Peter Alken
had an â€˜operative workshopâ€™ Organized at Manipal under the aegis of USI and ISU
wherein Madhu Agrawal as one of the moderators requested that every step of
Initial Puncture be demonstrated emphasizing repeatedly that this part had to
be learnt by all indepth to avoid Complications as a proper entry into the
collecting system is guided by the appropriateness of the Initial Puncture.
Both Operating Surgeons, Ravi and Arun, took special pains to demonstrate each
step for initial puncture. Punctures performed by Experts appear very simple
but it needs adequate exposure to master and even then at times initial
puncture could be difficult.
provided an article to SK pal for his commentary on â€˜PCNL: Initial Puncture by
Prof Peter Alkenâ€™. He has provided a Review on initial Puncture for PCNL. I am
providing his commentary along with the article of Peter Alken for your reading
by SK Pal:
make blatant statements like â€˜Accurate Initial puncture is the most important
step of PCNLâ€™.
We go on to
add that if a good puncture has been accomplished, more than 50% of the success
has been achieved.
But, do we
have robust literature, supporting these statements? How much is the influence of initial puncture
on the success, course, outcome and complications of PCNL?
seen appropriate initial punctures resulting in non-gratifying results or
worse- culminating in catastrophic complications and on the other hand, very
bad initial punctures, ultimately giving us very satisfactory outcomes.
Most of the
published literature on PCNL is silent on the influence of initial puncture.
Alken has attempted to collect recent published material over the last 5 years
on this issue and has summarized outcome of 193 references in an article published
on line on August 8th 2021 in BJUI titled â€“ â€˜Percutaneous Nephrolithotomy- the
Article has extensively studied the influence of various existing imaging
modalities and utilized access techniques for initial puncture. Ultimately, no conclusions
could be drawn and all imaging modalities and access techniques proved to be
also highlights the technological advances like electromagnetic or optical
tracking systems for accurate placement of initial punctures, which might
become very useful.
literature on inclusion of details and influence of initial puncture on outcome
of PCNL does not authenticate, support or deny the statements against initial
puncture being a significant influencer. Thus, the importance attributed to
initial puncture remains subjectively high but objectively low.
article should prompt the contributors to pay attention and include more
relevant details of initial puncture in their publications, so that more
detailed assessment and comparison can be made to derive conclusions.
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