Thoracoscopy as an Aid to Safer Intercostal Percutaneous Nephrostomy
The field of endourology continues to expand with procedures such as antegrade rigid ureteroscopy and endopyelotomy gaining in popularity. Percutaneous access to the upper or middle calyceal group is becoming necessary in an increasing number of patients. Punctures above the 12th or 11th rib in order to gain access to these calyces often pass through the pleura. Although complications are uncommon, they may be significant, and cases of pneumothorax, hydrothorax, haemothorax, empyema, and even loss of a calculus into the thoracic cavity have been reported. Thoracoscopy with a flexible nephroscope through the 7th or 8th intercostal space is a simple and safe procedure which makes it possible to visualize the needle traversing the thoracic cavity. In this way, injury to the lung can be avoided or a lower puncture site may be chosen in selected cases to avoid traversing the pleural cavity.