How is minimally invasive puncture surgery performed?

The placement of minimally invasive trocars for laparoscopic surgery depends on multiple factors including the surgical site, surgeon's preference, and the patient's lesion location. Taking percutaneous nephrolithotomy for kidney stones as an example, the procedure is as follows:

1. Anesthesia and disinfection: The physician administers local or general inhalation anesthesia to the patient, followed by local disinfection of the surgical site.

2. Puncture: A 1cm通道 (access tract) is created on the side of the waist corresponding to the affected kidney. Under ultrasound guidance, a puncture needle is inserted into the target renal calyx. When urine flows out after withdrawing the needle, it indicates successful puncture. A guidewire is then inserted through the needle, and the needle is removed.

3. Establishing a percutaneous renal tract: Guided by the guidewire, fascial dilators are used sequentially from small to large to dilate the puncture tract to approximately 1cm in diameter, followed by insertion of a peel-away sheath.

4. Stone removal: A nephroscope is inserted through the sheath to locate the stone. The stone is fragmented using pneumatic lithotripsy or ultrasonic lithotripsy and then flushed or suctioned out.

5. After inserting a ureteral stent, the nephroscope is withdrawn, and a nephrostomy tube is left in place. The procedure is then completed.