PCNL (percutaneous nephrolithotomy, keyhole surgery through the back to remove kidney stones) has changed enormously over my career. When I started in 1996, I performed large-diameter, first-generation PCNL. Since then I have routinely used every size of the procedure: standard PCNL, mini PCNL, ultra-mini PCNL and micro PCNL. I am proud to be one of the few urologists who have used all of them routinely.
So my journey started with a 30 French Amplatz sheath and has come down to an 18-gauge needle scope assembly. French is the scale for the width of these instruments, so that is a very large channel at one end and a needle at the other. What a change in technology.
A 4.5 French scope for the narrowest ureters
Richard Wolf has made a scope with a 4.5 French tip that makes my day. When the ureter is so narrow that nothing can pass, this scope feels like a miracle. In almost all such cases I am able to gain access and relieve the obstruction of the ureter.
I am also proud that Richard Wolf took my practical input into account while developing one of its endoscopes, a scope I love.
An in-line ultrasound probe for supine puncture
For puncturing the kidney I use a FUJIFILM Arietta 65 ultrasound machine with an in-line puncture probe, which can be plasma-autoclaved (sterilised). With it, the puncture for supine PCNL, where the patient lies on their back, is easy and precise, even in complex anatomy.
A drape hammock
I use a simple method to make a hammock from the distal end of the drape. With it, any equipment that slips down does not fall, get damaged, or become unsterile. This matters a lot for an easy flow during endourology.
Ergonomics in long cases
Ergonomics plays a big role in endourology. I have been lucky to use a chair that keeps me comfortable during long surgeries, and I often get up for a while to improve my circulation.