PCNL - Initial Puncture Prof Peter Alken
Recently we 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.
I had 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 and understanding.
With warm regards,
Commentary by SK Pal:
Often we 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?
Havenâ€™t we 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.
Prof. Peter 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 punctureâ€™
This 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 equal.
The Article also highlights the technological advances like electromagnetic or optical tracking systems for accurate placement of initial punctures, which might become very useful.
Paucity of 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.
This 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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