Use of a modified syringe barrel to ensure control of the Amplatz sheath during percutaneous nephrolithotripsy in obese patients.

Percutaneous nephrolithotripsy (PNL) has been shown to be safe and effective in obese patients. One technical problem specifically encountered in these patients is migration of the Amplatz sheath beneath the skin or muscle fascia. We describe a simple technique, making use of a modified 10-cc syringe barrel, to facilitate retrieval of a migrated access sheath in obese patients undergoing percutaneous nephrolithotripsy. This can also be adopted to prevent loss of the working sheath in the first place, as well as to provide some extra length to access the collecting system avoiding the need to convert to longer instrumentation. This technique is cheap, safe, and effective. It avoids the need to extend the skin incision, resulting in improved cosmesis and reduced postoperative pain.