Laparoscopic Port Lithotripter an Affordable and Low-Cost New Technique for Pneumatic Stone Destruction
SIU Academy®. Al-Ameedee M. 11/14/21; 342769; MVP-02.10 Topic: Health Economics
Dr. Mohammed Al-Ameedee
Dr. Mohammed Al-Ameedee
Contributions
Abstract
Laparoscopic Port Lithotripter an Affordable and Low-Cost New Technique for Pneumatic Stone Destruction

Topic: Stones

Applicant 1: Mohammed

Applicant 1: Al-Ameedee

Applicant 1: Ministry of Health, Diwanyia Teaching Hospital

Applicant 1: Iraq

Applicant 1: Presenting Author

Introduction and Objectives:

We used a low-cost and affordable technique for stone destruction used in both rural and urban areas especially in low-income countries.

Materials and Methods:

Pneumatic lithotripter is a useful instrument for stone destruction of renal, ureter or vesical stones during PCNL, ureteroscope or cystoscope respectively, but it is expensive (can reach up to $15,000). We used a 5 mm laparoscopic port as a lithotripter. This technique used instruments and materials available in the operative theatre; a 5 mm laparoscopic port, silicon or rubber tube for gas transmission like oxygen, CO2, or pressured atmospheric air. Connect the silicone tube (125 cm length) to an oxygen cylinder, with the other end connected to the laparoscopic port (external end). Another silicon tube (200 cm length) is connected to the other end of the laparoscopic port (shaft) and the other end of the tube connected to the lithotripter handle (handpiece). Open the oxygen cylinder valve to 3 - 5 bar, open and close the laparoscopic port sliding side valve. The gas transmitted to the lithotripter handle and the kinetic energy of a bolt is transferred via an elastic shock onto the proximal end piece of the intracorporal probe. The pulse movement of the distal section of the probe fragments the calculus with which it is in contact. The laparoscopic port side channel valve must be opened to exit the extra gas, the frequency of the handle probe controlled by the frequency of the sliding valve, and the degree of transmitted force is controlled by the pressure bar of the oxygen cylinder valve. Between October 2020 and April 2021, a total of 65 patients underwent percutaneous nephrolithotomy. The mean patient age was 32 years (range 16 to 70) and the male to female ratio was 2:1.

Results:

The mean operative time was 80 minutes (range 40 to 135). The mean stone size was 24 mm (range 10 to 50 mm). Spinal anesthesia 80% and general anesthesia 20%, all on prone position, with successful stone destruction. The hospital stay was 12 - 24 hours.

Conclusion:

This technique is inexpensive ($5), uses reusable second hand 5 mm laparoscopic port and silicone tubes, available in any operative theatre, affordable for urban or rural areas of low-income countries, with no need for electricity or maintenance.

Laparoscopic Port Lithotripter an Affordable and Low-Cost New Technique for Pneumatic Stone Destruction

Topic: Stones

Applicant 1: Mohammed

Applicant 1: Al-Ameedee

Applicant 1: Ministry of Health, Diwanyia Teaching Hospital

Applicant 1: Iraq

Applicant 1: Presenting Author

Introduction and Objectives:

We used a low-cost and affordable technique for stone destruction used in both rural and urban areas especially in low-income countries.

Materials and Methods:

Pneumatic lithotripter is a useful instrument for stone destruction of renal, ureter or vesical stones during PCNL, ureteroscope or cystoscope respectively, but it is expensive (can reach up to $15,000). We used a 5 mm laparoscopic port as a lithotripter. This technique used instruments and materials available in the operative theatre; a 5 mm laparoscopic port, silicon or rubber tube for gas transmission like oxygen, CO2, or pressured atmospheric air. Connect the silicone tube (125 cm length) to an oxygen cylinder, with the other end connected to the laparoscopic port (external end). Another silicon tube (200 cm length) is connected to the other end of the laparoscopic port (shaft) and the other end of the tube connected to the lithotripter handle (handpiece). Open the oxygen cylinder valve to 3 - 5 bar, open and close the laparoscopic port sliding side valve. The gas transmitted to the lithotripter handle and the kinetic energy of a bolt is transferred via an elastic shock onto the proximal end piece of the intracorporal probe. The pulse movement of the distal section of the probe fragments the calculus with which it is in contact. The laparoscopic port side channel valve must be opened to exit the extra gas, the frequency of the handle probe controlled by the frequency of the sliding valve, and the degree of transmitted force is controlled by the pressure bar of the oxygen cylinder valve. Between October 2020 and April 2021, a total of 65 patients underwent percutaneous nephrolithotomy. The mean patient age was 32 years (range 16 to 70) and the male to female ratio was 2:1.

Results:

The mean operative time was 80 minutes (range 40 to 135). The mean stone size was 24 mm (range 10 to 50 mm). Spinal anesthesia 80% and general anesthesia 20%, all on prone position, with successful stone destruction. The hospital stay was 12 - 24 hours.

Conclusion:

This technique is inexpensive ($5), uses reusable second hand 5 mm laparoscopic port and silicone tubes, available in any operative theatre, affordable for urban or rural areas of low-income countries, with no need for electricity or maintenance.

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