Utilization of Swiss LithoClast® Trilogy Lithotripter During Percutaneous Nephrolithotomy

Abstract

Objective: Percutaneous nephrolithotomy (PCNL) is the gold standard for surgical treatment of large kidney stones. Although there are a variety of commercially available Lithotrites, the objective of this video is to review technical aspects of the EMS Lithoclast Trilogy™ and to discuss tips for troubleshooting as well as set up of the device. Surgical Procedure: PCNL is recommended as first-line therapy for renal pelvic stones that are greater than 2 cm in size. Furthermore, PCNL should also be considered for lower pole stones that are > 1 cm in size. Results: The Trilogy uses a combination of ballistic and ultrasound energy to efficiently fragment stone. It is easy to set up. Tips to maximize efficiency of the device including priming the device and appropriate selection of the probe size. We prefer using lower frequency settings at the initiation of the case to suction out blood clot. Once the stone is identified we increase the frequency and impact settings. The surgeon should not torque on the handle as the probe will not function as efficiently and can even break prematurely. Conclusions: The Trilogy is a dual energy lithotrite available in a wide range of probe sizes. Bench and clinical data suggest it is equivalent or more efficient than other available Lithotrites. The surgeon should take care not to torque on the probe to ensure the probe does not break prematurely and functions at maximum efficiency.

Keywords

• Trilogy
• PCNL
• Staghorn