Percutaneous nephrolithotomy with ultrasound-assisted puncture: does the technique reduce dependence on fluoroscopic ionizing radiation?

Pulido-Contreras, Enrique; Garcia-Padilla, Miguel Angel; Medrano-Sánchez, Javier; Leon-Verdin, Guadalupe; Primo-Rivera, Miguel Angel; Sur, Roger L.

doi:10.1007/s00345-021-03636-2

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…In a classic access-establishing step via ultrasound guidance, the first difficulty is lack of experience on designing access sites and puncture angles [ 8 , 21 , 25 ]. It is usually the key to determine whether an access can remove as many stones as possible while not to swing the sheath too much [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotomy guided by 5G-powered robot-assisted teleultrasound diagnosis system: first clinical experience with a novel tele-assistance approach (IDEAL stage 1)

Yang,

Zhou,

Zhou

et al. 2024

BMC Urol

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Background To demonstrate the technical feasibility of percutaneous nephrolithotomy (PCNL) guided by 5G-powered robot-assisted teleultrasound diagnosis system (RTDS) in a complex kidney-stone (CKS) cohort and present our preliminary outcomes. PCNL is highly skill-required, which hinders it popularization in primary medical units of remote regions. We designed an innovative tele-assistance approach to make PCNL easy to be operated by inexperienced surgeons. Methods This was a prospective proof-of-concept study (IDEAL phase 1) on intraoperative tele-assistance provided by online urological experts via a 5G-powered RTDS. Total 15 CKS patients accepted this technology. Online experts manipulated a simulated probe to assist unskilled local operators by driving a patient-side robot-probe to guide and monitor the steps of access establishment and finding residual stones. Results Median total delay was 177ms despite one-way network-connecting distance > 5,800 km. No perceptible delay of audio-visual communication, driving robot-arm or dynamic ultrasound images was fed back. Successful tele-assistance was obtained in all cases. The first-puncture access-success rate was 78.6% with a one-session SF rate of 71.3% and without complications of grade III-V. Conclusions The current technology based on 5G-powered RTDS can provide high-quality intraoperative tele-assistance, which has preliminarily shown satisfactory outcomes and reliable safety. It will break down a personal competence-based barrier to endow PCNL with more popular utilization. Trial registration The study was approved by ethics committee of the Xinjiang Kezhou People’s Hospital and ethics committee of the First Affiliated Hospital of Nanjing Medical University and was registered on http://www.chictr.org.cn (ChiCTR2200065849, 16/11/2022).

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Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotomy guided by 5G-powered robot-assisted teleultrasound diagnosis system: first clinical experience with a novel tele-assistance approach (IDEAL stage 1)

Yang,

Zhou,

Zhou

et al. 2024

BMC Urol

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“…In the past, the PCNL puncture was done under the guidance of radiation; however, the surgeons and patients are exposed to radiation. According to the ICRP 60 report, the annual radiation dose for radiation workers is 20 mSv [ 22 , 23 ]. Previous studies have shown that the mean radiation dose received during PCNL surgery was 8.66 mSv [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to the ICRP 60 report, the annual radiation dose for radiation workers is 20 mSv [ 22 , 23 ]. Previous studies have shown that the mean radiation dose received during PCNL surgery was 8.66 mSv [ 23 ]. Ultrasound-guided puncture and tract establishment are, however, considered safe and effective, avoiding radiations, especially for young patients [ 7 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy and its initial clinical application

Hong

Wang

et al. 2022

BMC Urol

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Background To assess the outcome of the mini-track, mini-nephroscopy, mini ultrasonic probe percutaneous nephrolithotomy for upper ureteral and kidney stones. Methods We collected data of 53 patients (55 kidney units) who underwent mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy between September 2020 and March 2021. The study included single and upper ureteral stones from 12 kidneys, multiple stones from 28 kidneys, and staghorn stones from 15 kidneys. Results The mean operative duration was 50.6 min, ranging from 15 to 200 min, whereas the mean lithotripsy and stone removal time was 17.2 min (3–45 min). Moreover, the mean postoperative length of stay was 4.0 days (1–7 days). Besides, the stone-free rate (SFR) of discharge was 89.1% (49/55). The mean hemoglobin drop was 15.3 mg/dL, ranging 1–32 mg/dL. Out of the total cases, only 4 of them displayed minor complications. The outcomes of < 40 mm versus ≥ 40 mm calculi were compared by performing subgroup analysis. The results demonstrated a longer operation duration (65.2 vs. 40.2 min), higher complication rate (13.0% vs. 3.3%), and lower SFR in the ≥ 40 mm calculi subgroup. Conclusions In summary, mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy is an effective and safe method to treat patients with upper ureteral and kidney calculi. This is especially significant for the stone size of 20–40 mm, demonstrating excellent SFR and a lower complication rate.

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“…Classical publications on FPNL learning curves show that operating room (OR) time-related competence is reached after 60 cases, with acceptable radiation doses after 120 cases. Some recent clinical papers dealt with learning curves for UP [18], FPNL [19], UPNL [20] and FUPNL [21].…”

Section: Stone Scores and Learning Curvesmentioning

confidence: 99%

“…By switching from FP to UP the PNL-experienced surgeon can reduce his/her fluoroscopy-time by 75% within the first 15 cases [18]. UPNL works well in children who benefit most from radiation reduction [32].…”

Section: Ultrasonographymentioning

confidence: 99%

Percutaneous nephrolithotomy – the puncture

Alken

2021

BJU International

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ObjectiveTo determine what importance is given to the puncture and assistive technologies in percutaneous nephrolithotomy (PNL) in the current urological literature. MethodsPubMed was searched for English publications and reviews for the keywords: 'percutaneous nephrolithotomy', 'percutaneous nephrostomy', 'puncture'. The search was limited to the last 5 years, January 2016 until February 2021. Based on 183 abstracts, 121 publications were selected, read, and reviewed. References, older or seminal papers were read and cited if they contributed to a better understanding. A total of 198 references form the basis of this narrative review. ResultsThe puncture is frequently referred to as the most crucial part of PNL. In contrast, the influence of the puncture on the failure rate of PNL and the specific puncture-related complications seems to be low in the single-digit percentage range. However, there are no universally accepted definitions and standards measuring the quality of puncture. Consequently, the impact of the puncture on general PNL complications, on stone scores predicting success rates and on learning curves evaluating surgeons' performance have not been systematically studied. Assistive technologies rely on fluoroscopy and ultrasonography, the latter of which is becoming the preferred imaging modality for monitoring the entire procedure. Needle bending, a problem relevant to all puncture techniques, is not addressed in the urological literature. ConclusionsThe importance attached to puncture in PNL in the current urological literature is subjectively high but objectively low. Some basics of puncture are not well understood in urology. Disciplines other than urology are more actively involved in the development of puncture techniques.

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Percutaneous nephrolithotomy with ultrasound-assisted puncture: does the technique reduce dependence on fluoroscopic ionizing radiation?

Cited by 7 publications

References 21 publications

Percutaneous nephrolithotomy guided by 5G-powered robot-assisted teleultrasound diagnosis system: first clinical experience with a novel tele-assistance approach (IDEAL stage 1)

Percutaneous nephrolithotomy guided by 5G-powered robot-assisted teleultrasound diagnosis system: first clinical experience with a novel tele-assistance approach (IDEAL stage 1)

Mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy and its initial clinical application

Percutaneous nephrolithotomy – the puncture

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