The fluoroscopic guidance of
percutaneous nephrolithotomy (PCNL) is a worldwide
known procedure. Currently, more and more
practitioners perform renal puncture in monoplanar
fluoroscopic projection without need of moving the Carm.
The depression of the tip of he calyx is the proof of
the perfect position of the needle.
However, in the case of dificult renal puncture, the
surgeon or the radiologist is forced to manipulate the Carm to delineate the position of the needle either it is
anterior or posterior to the calyx.
The interpretation of the fluoroscopic view is still
sometimes subject to confusion especially for nonexpert
: the understanding of fluoroscopic findings is
based on geometrical considerations. the authors
propose a well-illustrated essay trying to explain the
movement of the C-arm in case of failed calyceal
puncture in diferent directions.
: the surgeon or the radiologist needs after
asessement of the first puncture, to move the C-arm in
his preferred plan to delineate precisely in which
location is the needle in relation to the calyx and adjust
accordingly the position of the needle.
Keywords : Image guided surgery, urinary stone, fluoroscopy, percutaneous nephrolithotomy, percutaneous nephrostomy.