An Innovative Free-Hand Puncture Technique to Reduce Radiation in Percutaneous Nephrolithotomy Using Ultrasound with Navigation System Under Magnetic Field: A Single-Center Experience in Hong Kong

Chau, Hin Lysander; Chan, Hoi Chak Wilson; Li, Ting Bong Thomas; Cheung, Michael K.; Lam, Kin Man; So, Hing Shing

doi:10.1089/end.2015.0296

Cited by 13 publications

(6 citation statements)

References 20 publications

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“…In detail, 11 studies were about radiation exposure and associated harms [ [3] , [4] , [5] , [6] , [7] , [8] , 10 , 11 , [14] , [15] , [16] ]; 19 studies analyzed data on flexible or semirigid URS [ 18 , 19 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ]; nine studies assessed factors that affect radiation exposure during PCNL [ [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ]; 21 studies evaluated several methods of renal puncture and their effect on radiation [ [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ]; two studies reported outcomes on tract dilation [ 68 , 69 ] and another two protocols for reduction of radiation during the whole procedure [ 70 , 71 ]. Regarding general measures that should ...…”

Section: Resultsmentioning

confidence: 99%

“…Another promising category of renal puncture techniques is the use of magnetic fields created in the operating room, which guide needles with sensors to perform a safe and accurate puncture. During the puncture step, the needle is followed with ultrasound [ 64 , 65 ] or guided only by sensors and the position is confirmed using a ureterorenoscope [ 66 ]. Obesity and calyces occupied by large stone burden may impair successful puncture using these methods [ [64] , [65] , [66] ].…”

Section: Discussionmentioning

confidence: 99%

“…During the puncture step, the needle is followed with ultrasound [ 64 , 65 ] or guided only by sensors and the position is confirmed using a ureterorenoscope [ 66 ]. Obesity and calyces occupied by large stone burden may impair successful puncture using these methods [ [64] , [65] , [66] ]. Finally, robotic devices (AcuBot, John Hopkins MrBot, and PAKY-RCM) have been designed to facilitate needle guidance and avoid operator dependence [ 67 ].…”

Section: Discussionmentioning

confidence: 99%

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Radiation protection measures during endourological therapies

Tzelves

Juliebø-Jones

Manolitsis

et al. 2023

Asian Journal of Urology

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiation protection measures during endourological therapies

Tzelves

Juliebø-Jones

Manolitsis

et al. 2023

Asian Journal of Urology

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“…Another disadvantage is that the patient anatomy is obtained in 2D. A similar approach was reported by Chau et al [21], who performed 18 PCNL cases using magnetic field-based ultrasound navigation to visualize the position of the needle tract in relation to the target calyx. Puncture was performed freehand without a needle-guiding system attached to the transducer.…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopy-assisted Percutaneous Kidney Access Made Easy: First Clinical Experience with a Novel Navigation System Using Electromagnetic Guidance (IDEAL Stage 1)

et al. 2017

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E U R O P E A N U R O L O G Y X X X ( 2 0 1 7 ) X X X -X X X a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Article info AbstractBackground: Puncture of the renal collecting system represents a challenging step in percutaneous nephrolithotomy (PCNL). Limitations related to the use of standard fluoroscopic-based and ultrasound-based maneuvers have been recognized. Objectives: To describe the technique and early clinical outcomes of a novel navigation system for percutaneous kidney access. Design, setting, and participants: This was a proof-of-concept study (IDEAL phase 1) conducted at a single academic center. Ten PCNL procedures were performed for patients with kidney stones. Surgical procedure: Flexible ureterorenoscopy was performed to determine the optimal renal calyx for access. An electromagnetic sensor was inserted through the working channel. Then the selected calyx was punctured with a needle with a sensor on the tip guided by real-time three-dimensional images observed on the monitor. Outcome measurements and statistical analysis: The primary endpoints were the accuracy and clinical applicability of the system in clinical use. Secondary endpoints were the time to successful puncture, the number of attempts for successful puncture, and complications. Results and limitations: Ten patients were enrolled in the study. The median age was 47.1 yr (30-63), median body mass index was 22.85 kg/m 2 (19-28.3), and median stone size was 2.13 cm (1.5-2.5 cm). All stones were in the renal pelvis. The Guy's stone score was 1 in nine cases and 2 in one case. All 10 punctures of the collecting system were successfully completed at the first attempt without X-ray exposure. The median time to successful puncture starting from insertion of the needle was 20 s (range . No complications occurred. Conclusions: We describe the first clinical application of a novel navigation system using real-time electromagnetic sensors for percutaneous kidney access. This new technology overcomes the intrinsic limitations of traditional methods of kidney access, allowing safe, precise, fast, and effective puncture of the renal collecting system. Patient summary: We describe a new technology allowing safe and easy puncture of the kidney without radiation exposure. This could significantly facilitate one of the most challenging steps in percutaneous removal of kidney stones.

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“…In addition, new working techniques and work steps must be learned and practiced by the user. The future trend of percutaneous renal access is evolving away from fluoroscopically assisted puncture, to reduce radiation exposure [20]. This could reduce the harmful long-term effects of radiation exposure and make the use of PCNL in pediatric urology [21] safer.…”

Section: Original Articlementioning

confidence: 99%

Visually navigated, ultrasound-guided, freehand percutaneous calyceal puncture – preclinical evaluation of a novel device to simplify a complex surgical task

Wakileh,

Hohmann,

Rassweiler-Seyfried

et al. 2024

Ultrasound Int Open

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Purpose Freehand sonographic percutaneous puncture techniques for the renal calyceal system are on the rise. Much time and practice are required to master this technique. Navigation-supported puncture aids could help make percutaneous access easier and faster. The aim of this study was to determine whether navigated puncture is feasible, and whether it is easier and faster compared to the conventional sonographic procedure. Materials & Methods We performed prospective free-hand percutaneous puncture on a porcine kidney model embedded in gelatin using the Xperius ultrasound system in combination with needle tracking with a Stimuplex Onvision hollow needle, compared to the conventional freehand ultrasound puncture technique. Punctures were performed by 25 participants using the ultrasound machine with or without needle tracking mode. Results Compared to the conventional approach, the navigated approach reduced the number of puncture procedures by 0.2 attempts(8%) in the experienced group. The time to calyx access was reduced by 15 seconds (26%). In the novice group, navigated puncture required 1.2 fewer attempts (36%) and the time to access was 70 seconds faster (61%). Conclusion Puncture using the novel device is feasible. The number of punctures and the time needed for successful access of the calyceal system was reduced by use of navigation in both groups, although the trend was significant only in the novice group. Navigation using needle tracking seems to help beginners perform sonographic percutaneous puncture at a level similar to experienced users. For a more precise analysis and validation, further studies are needed.

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An Innovative Free-Hand Puncture Technique to Reduce Radiation in Percutaneous Nephrolithotomy Using Ultrasound with Navigation System Under Magnetic Field: A Single-Center Experience in Hong Kong

Abstract: USNS can provide radiation-free guidance for tract creation in PCNL. It is predictable, precise, reliable, and safe. Most importantly, the technique is easy to learn, particularly for urologists who are new to PCNL.

Cited by 13 publications

References 20 publications

Radiation protection measures during endourological therapies

Radiation protection measures during endourological therapies

Ureteroscopy-assisted Percutaneous Kidney Access Made Easy: First Clinical Experience with a Novel Navigation System Using Electromagnetic Guidance (IDEAL Stage 1)

Visually navigated, ultrasound-guided, freehand percutaneous calyceal puncture – preclinical evaluation of a novel device to simplify a complex surgical task

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