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

Abstract

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.

Electromagnetic Guided Percutaneous Renal Access Outcomes Among Surgeons and Trainees of Different Experience Levels: A Pilot Study

“…All 10 punctures were performed with EM guidance alone on the first attempt. 12 Each of the aforementioned studies of EM-access noted a reduced learning curve as one of the potential advantages of this approach. Our findings are the first to corroborate this in a formal sense both in comparison of outcomes between different surgeon experience levels as well as in comparison to an existing alternative technique for PCNL access.…”

Application of Three-dimensional Visualization assisted Ultrasound for Percutaneous Renal Puncture

“…Accurate target percutaneous renal calyx longitudinal puncture has always been the biggest challenge in percutaneous renal surgery. In recent years, a variety of percutaneous renal puncture navigation systems have emerged, including electromagnetic positioning navigation 11 and iPad augmented reality navigation 12 and so on. The above techniques can achieve fast and safe puncture in the operation to some extent, but their disadvantages are also signi cant.…”

Robot-Assisted Fluoroscopy Versus Ultrasound-Guided Renal Access for Nephrolithotomy: A Phantom Model Benchtop Study

“…8 Another interesting access method utilizing ureteroscopy-assisted PCNL with electromagnetic guidance has been shown to be an effective and safe renal access technique in a previous trial. 9 We previously reported the efficacy of endoscopic intrarenal surgery, which utilized a flexible ureteroscope to assist percutaneous access and lithotripsy. 10 Although the combination of ultrasound (US) and fluoroscopic guidance has been our primary method for renal access, recent development in the US technique with real-time virtual sonography provided a safer access into the renal collecting system.…”