Ultrasound-guided renal access and balloon dilation for PCNL in the prone position: results of a multicenter prospective observational study

Su, Boxing; Song, Haifeng; Yang, ZeSong; Yang, Wenzeng; An, Feng; Chen, Fangzhi; He, Peng; Li, Gonghui; Wu, Haiyang; Yang, Jinjian; Li, Songchao; Liu, Yubao; Bai, Wenjie; Wang, Shu; Xiao, Bo; Hu, Weiguo; Li, Jianxing

doi:10.1007/s00345-022-04072-6

Cited by 5 publications

(7 citation statements)

References 19 publications

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Section: Discussionmentioning

confidence: 99%

“…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 ]. Under the current technology, online experts can give detailed advices by the interactive audio-visual subsystem, thus the experience-based barrier, which hindering PCNL popularization, will be broken down.…”

Section: Discussionmentioning

confidence: 99%

“…The first is that the robot-arm of RTDS greatly facilitates puncture operating. In a classic ultrasound-guided procedure, it is hard to maintain a needle-tip track always within the scanning plane when an operator holds a probe in one hand to guide and clenches a needle in the other to puncture [ 21 ]. In our procedure, local operators can puncture with both own hands and the probe is not easy to move and skid under the robot-arm control, which ensures the stability of ultrasound guidance (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Complications were recorded according to Clavien-Dindo grading system [ 20 ]. SF status was defined as no radiological evidence or only the presence of ≤ 4 mm asymptomatic fragments [ 14 , 21 ], and residual fragments of ≤ 4 mm were not counted into RSV. Stone clearance ratio (SCR) was calculated via the formula: (TSV- RSV)/TSV× 100%.…”

Section: Methodsmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Ultrasound, recognized for its safety and convenience, has been extensively employed in PCN needle guidance. However, recent studies on ultrasound-guided PCN have shown that the single-puncture success rate can range from 34.3% to 91.2% due to its limited visualization details [17-20]. Fluoroscopy is also an effective tool for renal access achievement due to its outstanding capacity in imaging contrast.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Nephrostomy Guidance by a Convolutional Neural Network Based Endoscopic Optical Coherence Tomography System

Wang,

Calle,

Yan

et al. 2024

Preprint

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Percutaneous nephrostomy (PCN) is a commonly used procedure for kidney surgeries. However, difficulties persist in precisely locating the PCN needle tip during its insertion into the kidney. Challenges for PCN needle guidance exist in two aspects: 1) Accurate tissue recognition, and 2) Renal blood vessel detection. In this study, we demonstrated an endoscopic optical coherence tomography (OCT) system for PCN needle guidance. Human kidney samples are utilized in the experiments. Different renal tissues including: 1) cortex, 2) medulla, 3) calyx, 4) fat, and 5) pelvis can be clearly distinguished based on their OCT imaging features. We conduct kidney perfusion experiments to mimic the renal blood flow. Our system can efficiently detect the blood flow in front of PCN needle using Doppler OCT function. To improve surgical guidance efficiency and alleviate the workload of radiologists, we employ convolutional neural network (CNN) methods to automate the procedure. Three CNN models including ResNet50, InceptionV3, and Xception were applied for tissue classification. All of them demonstrate promising prediction results, with InceptionV3 achieving the highest recognition accuracy of 99.6%. For automatic blood vessel detection, nnU-net was applied, and it exhibited intersection over unions (IoU) values of 0.8917 for blood vessel and 0.9916 for background.

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Ultrasound-guided percutaneous nephrolithotomy (PCNL) success rates in patients with elevated body mass index: a comparative study

Perez,

Neeman,

Dotan

et al. 2023

Urolithiasis

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Percutaneous nephrolithotomy (PCNL) is considered gold standard treatment of renal stones larger than 20mm. Several studies have shown that ultrasound guidance during this procedure is more effective and safer than uoroscopy. A higher body mass index (BMI) can make ultrasound-guided renal access more di cult and unsuccessful. We present a prospective analysis and comparison of ultrasound-guided PCNL in patients with normal and increased body mass index.We performed a prospective comparison of patients who underwent ultrasound-guided PCNL to remove renal stones by a single surgeon between 2020 and 2022. Patients with BMIs greater than 30 (mean 33.87-Obese) were compared to those with BMIs less than 30 (mean 25.69-non-Obese). Demographic, perioperative, and follow-up data were collected, analyzed, and included in this study.Total of 98 consecutive patients, with 49 patients in each group. No statistically signi cant differences were observed in terms of stone volume (p = 0.085), stone density (P = 0.5590), location of renal access (P = 0.108), surgery duration (P = 0.38), blood loss (P = 0.54), or laboratory changes after surgery (P = 0.60). 87.76% of obese patients were stone-free per CT scan at follow-up, compared to 73.47% of normalweight patients (P = 0.1238). According to Clavien Dindo classi cation, six patients in the non-obese group experienced grade II (10%) and grade III (2%) complications, as opposed to six patients in the obese group with grade I (2%), grade II (6%), and grade III (2%) complications.There was no signi cant correlation between body mass index and the success or safety of ultrasoundguided PCNL. Although more challenging, a higher BMI should not be an impediment to performing this approach. This method is safe, with no increased incidence of postoperative complications or compromise in stone-free status post-operatively and can diminish or avoid both patient's and medical team's exposure to ionizing radiation.

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Ultrasound-guided renal access and balloon dilation for PCNL in the prone position: results of a multicenter prospective observational study

Cited by 5 publications

References 19 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)

Percutaneous Nephrostomy Guidance by a Convolutional Neural Network Based Endoscopic Optical Coherence Tomography System

Ultrasound-guided percutaneous nephrolithotomy (PCNL) success rates in patients with elevated body mass index: a comparative study

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