Percutaneous nephrostomy: placement under laser guidance and real-time CT fluoroscopy

The purpose of this paper is to present our experience with real-time compu ted tomography (CT) fluoroscopy guided percutaneous nephrostomy (PNT) and t o describe this technique involving puncture under laser guidance. We attem pted 30 placements in 25 patients: puncture was directed by laser guidance and placement of the tube was made under real time CT fluoroscopy, 25 proce dures were performed in prone position and 5 procedures in the supine posit ion. The time necessary for the procedure ranged from 10 to 45 min (mean 25 min). The average duration of CT fluoroscopy per placement was 49 seconds (range 7-120 s). The PNT placement was successful as a sole procedure inclu ding puncture and catheter placement in 24 of 30 cases in the remainder of cases, puncture was performed under CT guidance but the catheter was defini tively positioned in conventional fluoroscopy. The CT fluoroscopy technique allows routine, efficient and safe PNT placement, especially when encounte ring difficult access to the pelvicaliceal system.