Aghamir Seyed Mohammad Kazem, Salavati Alborz
a Department of Urology , Sina Hospital, Tehran University of Medical Sciences , Tehran , Iran.
b Department of Urology , Yas Hosp, Tehran University of Medical Sciences , Tehran , Iran.
Minim Invasive Ther Allied Technol. 2018 Jun;27(3):143-147. doi: 10.1080/13645706.2017.1335644. Epub 2017 Jun 13.
Almost all endourologic procedures use fluoroscopic imaging in some steps, which exposes both the patient and the surgical team to considerable amounts of radiation. Primary reports on results of a simple direct visual endoscopic access sheath placement technique which does not use fluoroscopy at all are presented.
First a semi-rigid ureteroscopy was carried out up to the renal pelvis, then the access sheath (36 cm, 11/13 Fr) without the obturator was placed over a 7.5 Fr semi-rigid ureteroscope and ureteroscopy was repeated over the guide wire to the point where the sheath could be inserted without force as if the ureteroscope would act as the guide wire (rod), which is controlled under direct endoscopic vision.
Eighty-eight cases out of 106 procedures were successful regarding the insertion of the ureteral access sheath (UAS) under direct vision using a 36 cm 13/11 Fr sheath. Fourteen ureters had non-negotiable strictures needing stenting for passive dilation. The mean time for UAS insertion was 19 s. The stone free-rate was 78.12%. Among our 106 cases, there were six cases of the upper tract urothelial cancers.
Ureteral access sheath placement could be safely performed using a semi-rigid ureteroscope under direct visual control and resulted in shorter operative time, without radiation exposure during the RIRS procedure of both the patient and the surgery team.
几乎所有腔内泌尿外科手术在某些步骤都使用荧光透视成像，这使患者和手术团队都暴露于大量辐射中。本文首次报告了一种完全不使用荧光透视的简单直视内镜接入鞘置入技术的结果。
首先进行半硬性输尿管镜检查直至肾盂，然后将不带闭孔器的接入鞘（36厘米，11/13弗伦奇）套在7.5弗伦奇的半硬性输尿管镜上，沿导丝重复输尿管镜检查至能轻松插入鞘的位置，此时输尿管镜就如同导丝（杆）一样，在直视内镜下进行操作。
在106例手术中，88例在直视下成功置入了36厘米13/11弗伦奇的输尿管接入鞘（UAS）。14条输尿管存在无法通过的狭窄，需要置入支架进行被动扩张。UAS置入的平均时间为19秒。结石清除率为78.12%。在我们的106例病例中，有6例上尿路尿路上皮癌。
在直视控制下使用半硬性输尿管镜可安全地进行输尿管接入鞘置入，手术时间更短，在逆行肾内手术期间患者和手术团队均无辐射暴露。
