Percutaneous nephrolithotomy (PCNL) access to the superior calyx presents a unique challenge due to the increased risk of chest complications. This study describes a novel technique, termed the "Gopalakrishna Technique," for achieving renal descent to facilitate superior calyx access, particularly in patients with high-lying kidneys.

This technique utilizes an 18G Chiba needle, inserted percutaneously into the peri-renal fat (avoiding the renal parenchyma), to manipulate and displace the kidney inferiorly. Between 2021 and 2023, 42 patients undergoing PCNL for superior calyx calculi were included in the study. Patients with congenital renal anomalies, previous renal/retroperitoneal surgeries, or fixed kidneys were excluded. Following retrograde pyelography (RGP), the Chiba needle was positioned, and its lever-like action facilitated inferior renal displacement, allowing for subsequent access to the superior calyx.

The Gopalakrishna Technique yielded a 98% stone clearance rate. Two patients experienced significant bleeding requiring blood transfusion, while two others developed pleural effusions that were managed conservatively.

This study suggests that the Gopalakrishna Technique offers a simple, reproducible method for achieving superior calyx access during PCNL, demonstrating relatively low complication rates.