Ultrasound Guidance for Renal Tract Access and Dilation Reduces Radiation Exposure during Percutaneous Nephrolithotomy

Figure 2

Introduction of working wire and dilators using ultrasound guidance. (a) A J-tip coaxial wire is inserted through the needle after its tip is confirmed in the collecting system. The operative surgeon (S) controls the needle with dominant hand and holds the ultrasound probe with the nondominant hand while the assistant (A) controls the wire. (b) Ultrasonographic image of the kidney demonstrating the wire (white arrow) in the collecting system after needle withdrawal. Its appearance is highly echogenic and prominent. (c) For fascial dilation, a 10-French fascial dilator is passed over the wire. Again, the operative surgeon (S) holds the ultrasound probe and controls the dilator while the assistant (A) controls the wire. (d) As the fascial dilator passes over the working wire, the wire is seen very clearly as an echogenic line (white arrow). The dilator obscures the view of the wire and this interface of the echogenic wire and the area where the wire disappears from view is the tip of the fascial dilator (yellow arrow).

(a)

(b)

(c)

(d)