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Introduction and objectives: When using the flexible ureteroscope, there is a large outflow or backflow with the standard rubber cap. Especially, when using a basket, guidewire or laser fiber. In this case, the ureteroscope-seal is efficient to prevent irrigant backflow and secure devices inserted through the working channel. However, if the fibroscope-seal is not available, is there an option?

The injection port of a serum bag can be used.

Material and methods: In the beginning of the endourologic procedure, the sterile empty 500 ml serum bag is kept on the operating table. The injection port is harvested from the serum-bag. The whole length can be used or it can be shortened. Then, the injection port is adapted to the working channel of the flexible uretero-renoscope, nephroscope, or cystoscope. To insert a device (basket, guidewire..), the puncture needle is inserted from inside-out in the injection port, then the basket is inserted into the needle and it is attracted through the port.

Results: the injection port fit perfectly to the working channel of flexible scope, thus, there is no longer any backflow. Moreover, there is no backflow with any instrument inserted in the working channel guidewire, basket, or laser fiber, even with large movements of the instrument.

Limitations: However, the spontaneous insertion of a device, guidewire, basket or laser fiber, is almost impossible. It necessitates the use of the puncture needle or an introducer. Moreover, since the rubber of the injection port is so tight, the progression of the basket or guidewire is difficult. However, this limitation can be used to reduce the movements and to secure the inserted device: baskets, guidewire, or laser fiber.

 

Conclusion: the injection port of a serum bag can be adapted perfectly to the working channel of the flexible scope and it is watertight without any irrigant outflow. It is a good cost-free alternative to the ureteroscope-seal.

[thumbnail] => uploads/videos/576/thumbnail.JPG [public] => [publish] => 1 [sort] => 1 [views] => 79 [authors] => [link] => http://uroweb.org/guideline/urolithiasis/#3_4 [links] => [partner_id] => [partner_group_id] => [instruments] => [created_at] => 2016-12-12T18:02:58 [created_by] => 4 [modified_at] => 2017-09-15T07:53:59 [modified_by] => [modifiedBy] => [createdBy] => stdClass Object ( [id] => 4 [role_id] => 1 [username] => uroweb [email] => info@uroweb.org ) [surgeon] => stdClass Object ( [id] => 67 [user_id] => 71 [surgeon_group_id] => 15 [firstname] => Mohammed [initials] => M. [lastname] => Lezrek [picture] => uploads/surgeons/67/untitled.png [expertise] => Endourology Lower Urinary Tract [biography] => [created_at] => 2016-12-12T17:58:01 [created_by] => 4 [modified_at] => 2016-12-12T17:59:40 [modified_by] => 4 [lft] => 67 [rght] => 68 [parent_id] => [modifiedBy] => stdClass Object ( [id] => 4 [role_id] => 1 [username] => uroweb [email] => info@uroweb.org ) [createdBy] => stdClass Object ( [id] => 4 [role_id] => 1 [username] => uroweb [email] => info@uroweb.org ) ) ) [1] => stdClass Object ( [id] => 577 [surgeon_id] => 67 [show_co_surgeons] => [step_id] => 327 [step_type_id] => [step_sub_type_id] => [name] => A simple trick to facilitate the introduction of a J-tip guidewire [filename] => uploads/videos/577/video.mp4 [short_description] => [long_description] =>

Introduction and objectives: the introduction of a j-tip guidewire, through the puncture needle or a catheter, can be tricky. Normally, both hands are needed. The J-straightener or introducer does not simplify the technique much: Also, both hands are needed; otherwise, the guidewire have to be placed in the J-straightener before beginning the procedure or by the help during the procedure. The guidewire might slip from the J-straightener or the introducer might fall complicating more this simple procedure.

We present our experience of a simple trick to facilitate the introduction of a J-tip guidewire without using the J-straightener.

Materials and methods:

We present a straightening technique that can be performed single handedly. A J-tip Tefon guidewire is firmly held between index and thumb, a few centimeters below the tip. Simultaneously, the other fingers of the same hand do traction on the body of the guidwire against the palm of the hand. Thus, the tip is straightened.   

Results: the technique is possible single handedly, and allows the introduction of the guidewire without letting-go of the puncture-needle. It is much quicker and sure than using a J-straightner.

A guidewire is composed of wire wounded around a steel core. Traction on the body of the guidewire, while firmly holding the guidewire near the tip, will lead to a tightening of the wounded wire in the tip, which will lead to the straightening of the j-tip.

However, this technique is possible only with a Teflon guidewire and not with a hydrophilic guidewire.
 

Conclusion: the straightening of a J-tip Teflon guidewire is possible single handedly, and without the use of a J-straightener. This technique simplifies and facilitates the introduction of a J-tip guidewire.

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