ECIRS using Trilogy (EMS)

Clinical History:

• Left Kidney Stones: upper calyx 12x9x7mm, 600HU

• Left Kidney Stone: lower calyx 15x14x6mm, 650 HU

• Prostatectomy for Prostate cancer 2002

Technique Description:

• ECIRS (Combined intrarenal surgery)

• The Patient is positioned in a modified supine Valdivia Galdakau position. 2 surgeons will treat the patient simultaneously

• It is a combination of retrograde flexible ureteroscopy (RIRS) and mini PNL

Steps in the procedure:

• Patient Positioning in supine Valdivia Galdakau Position

• Cystoscopy and retrograde pyelography

• RIRS

• Ultrasound guided puncture of the lower calyx –endoscopic controlled

• One step dilation to the 17.5 Charr Sheet

• Mini PNL using Storz M 12 Charr

• Stone disintegration using Trilogy (EMS)

• Simultaneous RIRS to capture the stones in the upper calyx

• Removal of the PNL Sheet

• Removal of the flexible ureterenoscope and placement of a stent in the ureter

Learning points:

• Patient positioning

• Endoscopic controlled renal puncture

• Trilogy settings