User:Tejnaksh/"5-PANG technique"

Introduction: Percutaneous nephrolithotomy (PCNL) is a routinely performed procedure. An innovative 5 part Percutaneous Access Needle over Glidewire (5-PANG) technique has been described by the Institute of Urology, Dhule India, in an attempt to make percutaneous nephrolithotomy (PCNL) tract establishment and initial dilatation a fast, safe and less cumbersome procedure.

Procedure: An access needle (5-PANG needle) has been designed and fabricated by Institute of Urology, Dhule India. The objective was to reduce the repeated exchange of needles / dilators needed in a conventional PCNL tract creation, without compromising safety of the procedure. The needle has 5 parts. The first 3 parts when assembled measure 18G in thickness. The 4th and the 5th part when assembled augment the outer diameter of the needle to 9 Fr. PCNL is performed in prone position under general anaesthesia. Retrograde ureteric catheterisation and fluoroscopy helps visualization of the desired renal unit. The 5-PANG needle is then used for establishing percutaneous renal access as follows. Step 1: The inner 3 parts of the needle are used to puncture the pelvicalyceal system (PCS) using the classical Bull’s eye technique. The inner two parts (part 1 and 2) are then removed. The ureteric catheter is used to fill the PCS with saline. Fluoroscopy and retrograde free flow of saline out of part 3 confirms a successful puncture. The terumo glide wire is then parked into the PCS/ureter through part 3. STEP 2: The 4th and 5th part are then telescoped over the third part into the PCS till the markings on the outer aspect of the 3rd and 4th parts respectively. The 3rd and 4th parts are then removed. Retrograde free flow of saline and fluoroscopy confirms the position of part 5. The option of using a safety guide wire, if desired, exists at this step. STEP 3: A standard Alken’s dilator central rod is then introduced through part 5. Part 5 is removed keeping the Alken’s rod in situ; and conventional tract dilation performed. Fluoroscopy is used as and when required to confirm the position of the needles/dilators.

The 5-PANG technique is safe, fast and effective for percutaneous renal access and initial tract dilatation during a PCNL. It is easy to learn and master. It is cheap and makes the procedure cost effective. We recommend this technique over the standard initial tract dilatation technique.