Benefits of performing PCN through Brodels line

What are the benefits of performing PCN through Brodels line?

The approach through Brodel’s line also results in a percutaneous nephrostomy catheter exiting through skin near the posterior axillary line.

So the catheter does not kink and the patient is not uncomfortable lying on it when supine.

Percutaneous nephrolithotomy (PCN) is a minimally invasive procedure used to remove kidney stones. Brodels line, also known as the triangle of Brodel, is an anatomical landmark that can guide the placement of the percutaneous access during PCN.

Here are the benefits of performing PCN through Brodels line:

1. Safety: Brodels line helps identify a safe entry point for percutaneous access, reducing the risk of injury to surrounding structures such as blood vessels and the colon. It provides a reliable reference for the optimal puncture site, minimizing the chances of complications.
2. Direct access to the collecting system: By following Brodels line, the access point is positioned directly into the renal collecting system, allowing direct visualization and manipulation of the kidney stones. This facilitates effective stone removal and reduces the need for additional procedures.
3. Efficient stone clearance: PCN performed along Brodels line provides a more direct route to the stone, enabling efficient stone fragmentation and removal. It allows the urologist to access the stones without traversing a long and convoluted path, leading to improved outcomes in terms of stone clearance.
4. Minimizes renal damage: By following Brodels line, the puncture trajectory is optimized to minimize renal damage. The path is selected to avoid critical structures and maximize the clearance of stones while preserving the normal functioning renal tissue.
5. Reduced operative time: The use of Brodels line as a guide during PCN helps streamline the procedure and reduce operative time. It provides a standardized approach, making the puncture site selection and access more efficient.

It’s important to note that the use of Brodels line is just one technique among various approaches used in PCN. The choice of the access site may also depend on other factors, such as stone location, size, and individual patient anatomy. The urologist will consider all these factors to determine the most appropriate technique and approach for each patient.

It’s recommended to consult with a qualified urologist who can assess your specific case and determine the best approach for PCN based on your individual needs and circumstances.

What is Brodels line?

• The division in anterior and posterior branches of the renal artery implies the existence of an avascular plane, the so call Brodel’s line.
• This longitudinal zone is described along the convex renal border or just posterior to the lateral aspect of the kidney.
• A study was conducted to describe the extension of Brodel’s line with reference to the renal segments.
• 12 kidneys were injected with acrylic resins to obtain vascular corrosions casts that were analyzed also with computed tomography.
• It was observed the presence of a relative avascular plane in all vascular casts, located on the posterior surface, ascribable to the Brodel’s line.
• In 33% of cases the line extended from the apical to the inferior segments, in the 33% of cases it extended from the superior to the inferior segments, in 33% of cases it is limited to the superior and middle segments.
• Since the Brodel’s line corresponds with the plane of the anterior surface of the posterior hilar calyces, the knowledge of its extension is relevant from the surgical point of view: this area permits a relatively safe access route to the pelvicalyceal system for nephrostomy insertion and incision within this plane results in significantly less blood loss than outside this plane.

Avascular plane of Brodel

The avascular plane of Brodel is the section of renal parenchyma between 2/3 anterior and 1/3 posterior kidney on the cross-section that is relatively avascular.

The reason for its relative avascularity is that it represents the plane where the anterior and posterior segmental renal artery branches meet.

It is located just posterior to the lateral convex border of the kidney and permits a relatively safe access route to the pelvicalyceal system for nephrostomy insertion.