User:Tejnaksh/5-PANG technique

The 5-PANG techniqueis an innovative initial tract dilator designed by Dr Ashish Patil at the Institute of Urology Dhule, India. An access needle 5-PANG needle was initially fabricated with the objective of reducing the repeated exchange of needles and dilators needed in a conventional PCNL tract creation and to define a faster way of tract establishment, without compromising the 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 augments the outer bore of the needle to 12 Fr. The 5-PANG needle is used for gaining percutaneous renal access. The needle has been designed with 5 parts. The Step 1 involves using the inner 3 parts of the needle to puncture the pelvicalyceal system (PCS) using the classical Bull’s eye technique. The inner two parts are then removed, free flow of irrigation via the ureteric catheter and fluoroscopy confirms a successful puncture. The terumo glide wire is then parked into  the PCS. STEP 2: The 4 th and 5 th 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 inner 3rd and 4th parts are then removed and free flow of irrigation confirmed again. A safety guide wire can then be inserted if desired. STEP 3: A standard Alken’s dilator central rod is then inserted through the 5th part. The 5th part is then removed and a conventional tract dilation is then performed over the rod. Fluoroscopy is used as when required to confirm the position of the needles.