Kidney access device.

INTRODUCTION: Percutaneous nephrolithotomy is the most complicated stone surgery technique to learn. The steep learning curve is related mainly to obtaining precise renal access by puncturing the targeted calyx. A minimally misaligned puncture may lead to torrential bleeding, failure of the surgery, and complications. Renal puncture can take a long time, and the increased fluoroscopic time is a hazard for the patient and surgeon. METHODS: To aid in renal puncture and overcome the learning curve associated with learning the renal puncture technique, we designed a kidney access device (KAD), which helps align the 3-dimensional targeted calyx under fluoroscopy for precise needle placement. The KAD allows access to calyces at all angles. A 3-step puncture technique was formulated for puncturing the kidney using the KAD in a porcine model (with comparable renal size and anatomy with humans). To evaluate the practicality of the KAD and its possible advantages and limitations, the KAD was used to puncture 3 targeted calyces of bilateral kidneys in 4 pigs. Guidewires were inserted into the renal collecting system through the placed needle. RESULTS: Mean time per puncture was 4 ± 2 minutes (n = 24). Necropsy showed no retroperitoneal hematoma, visceral organ injury, or active bleeding from kidneys in any of the pigs. Kidneys were dissected and precise intrarenal placements of guidewires in relation to targeted calyces were noted at all 24 sites. CONCLUSIONS: The KAD with the 3-step technique aids in the safe and accurate renal puncture, even in novice hands, while drastically reducing operative and fluoroscopy time. The KAD may also be used to access other organs and has potential applications in minimally invasive surgery.

Setons in the treatment of anal fistula: review of variations in materials and techniques.

AIM: Anorectal fistulas have been a common surgical problem since ancient times. Age-old seton techniques are still practiced successfully in the treatment of complex anal fistulas. Many variations in materials and techniques are described in the literature. The selection of a seton type and technique depends on personal preferences. Our aim was to put together all the available variations in materials and techniques for seton treatment. This comprehensive review will help the surgeon to become more familiar with the various options available with regard to materials and techniques. METHODS: A review of the literature using Medline was done using the Key Words 'anal fistula' and 'seton'. All articles published in English were reviewed. The articles which had variations in materials and techniques for seton treatment were studied. RESULTS: Various aspects of variations in materials, insertion techniques, maintenance of tension, mechanisms of action, drainage techniques and changing the seton have been elaborated in detail. CONCLUSIONS: Throughout this paper we present the various available variations in setons with regard to materials, placement and maintenance techniques. This study will help clinicians in choosing a new seton variation or modifying their current method of treatment with setons.