title: Thoracoscopy-assisted high intercostal percutaneous renal access.
abstract: OBJECTIVE
  We describe a technique for safely accessing an upper pole calix through a 9th or 10th intercostal puncture.
  
  
  METHODS
  A 9th or 10th intercostal access was used for percutaneous nephrolithotomy (PCNL) in nine patients. Thoracoscopy via the 5th or 6th intercostal space was used to ensure safe passage of the nephrostomy needle.
  
  
  RESULTS
  Access was obtained in all patients without visceral injury. Seven patients were stone free after PCNL; the initial two required sandwich therapy to become so. Chest tubes were inserted routinely in the first eight cases. They were removed on postoperative day three and did not affect the length of hospital stay.
  
  
  CONCLUSIONS
  Access through the 9th or 10th intercostal space is occasionally necessary and is ideal in certain circumstances. Thoracoscopy-assisted percutaneous renal access allows access under direct vision, thus preventing pulmonary injury.
authors.affiliation: Division of Urology, St. Michael's Hospital, University of Toronto, ON, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Finelli
authors.forename: R J
authors.initials: RJ
authors.lastname: Honey
mesh_terms: D006801:Humans; D007366:Intercostal Muscles / Q000601:surgery*; D007668:Kidney / Q000601:surgery*; D007669:Kidney Calculi / Q000601:surgery*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011677:Punctures; D013906:Thoracoscopy; D016896:Treatment Outcome