Supra-twelfth supracostal access: when and where to puncture?
OBJECTIVE
Supracostal access for percutaneous renal surgery raises concern for the intrathoracic complications of the puncture. We analyzed the incidence of pleural transgression and intrathoracic complications after supracostal punctures in relation to the site of puncture (medial v lateral placement) and the respiratory phase during the puncture.


METHODS
We conducted a prospective study of 28 consecutive supracostal accesses in our department. All the punctures were made by the treating urologist under fluoroscopic guidance. Punctures were made during the normal respiratory cycle, and dilatation was up to 30F. Postoperatively, chest radiography and CT of the chest and upper abdomen were performed for evaluation of complications.


RESULTS
All supracostal accesses were supra-12th rib only. The average distance from midline of the site of puncture on the skin was 8.2 cm (range 5.5-9.1 cm). Complete stone clearance was achieved in 27/28 (96.4%) of the renal units. One patient had symptomatic hydrothorax necessitating chest tube placement. None of the patients had any lung or solid organ (liver or spleen) injury on CT imaging. Three patients had mild pleural effusion without symptoms, which was detected on postoperative CT.


CONCLUSIONS
Laterally placed supra-12th rib punctures made during the normal ventilatory cycle have an acceptably low pleural morbidity and no risk of lung injury.
Yadav
Rajiv
R
Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Gupta
Narmada P
NP
Gamanagatti
Shivanand
S
Yadav
Poonam
P
Kumar
Rajeev
R
Seith
Amlesh
A
D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D011182:Postoperative Care; D011677:Punctures / Q000009:adverse effects; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D012272:Ribs / Q000601:surgery*