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CC BY-NC-ND 4.0 · Ultrasound Int Open 2024; 10: a23247668
DOI: 10.1055/a-2324-7668
Original Article

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

Gamal Anton Wakileh
1   Urology, University Ulm Medical Centre, Ulm, Germany (Ringgold ID: RIN27197)
,
Manuel Hohmann
2   Urology, University Hospital Ulm, Ulm, Germany (Ringgold ID: RIN27197)
,
Marie Claire Rassweiler-Seyfried
3   Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany (Ringgold ID: RIN36642)
,
Jan Thorsten Klein 
1   Urology, University Ulm Medical Centre, Ulm, Germany (Ringgold ID: RIN27197)
4   Urology, Spital Thurgau AG, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
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Abstract

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.

Keywords

navigation - percutaneous kidney puncture - kidney stone surgery - renal access - PCNL

Supplementary Material



Publication History

Received: 20 November 2022

Accepted after revision: 01 May 2024

Article published online:
15 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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Bibliographical Record
Gamal Anton Wakileh, Manuel Hohmann, Marie Claire Rassweiler-Seyfried, Jan Thorsten Klein. Visually navigated, ultrasound-guided, freehand percutaneous calyceal puncture – preclinical evaluation of a novel device to simplify a complex surgical task. Ultrasound Int Open 2024; 10: a23247668.
DOI: 10.1055/a-2324-7668
 

  • References

  • 1 Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 1955; 157: 891-894
    Search in Google Scholar
  • 2 Bayne DB, Usawachintachit M, Tzou D. et al. Increasing Body Mass Index Steepens the Learning Curve for Ultrasound-guided Percutaneous Nephrolithotomy. Urology 2018; 120: P68-73
    Search in Google Scholar
  • 3 Honey RJDA, Wiesenthal JD, Ghiculete D. et al. Comparison of supracostal versus infracostal percutaneous nephrolithotomy using the novel prone-flexed patient position. J Endourol 2011; 25: 947-954
    Search in Google Scholar
  • 4 Hoznek A, Ouzaid I, Gettman M. et al. Fluoroscopy-guided renal access in supine percutaneous nephrolithotomy. Urology 2011; 78: 221-224
    Search in Google Scholar
  • 5 Lojanapiwat B, Prasopsuk S. Upper-pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. J Endourol 2006; 20: 491-494
    Search in Google Scholar
  • 6 Song Y, Ma Y, Song Y, Fei X. Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance. PLoS ONE 2015; 10: e0132986
    Search in Google Scholar
  • 7 Miller NL, Matlaga BR, Lingeman JE. Techniques for fluoroscopic percutaneous renal access. J Urol 2007; 178: 15-23
    Search in Google Scholar
  • 8 Desai M. Ultrasonography-guided punctures-with and without puncture guide. J Endourol 2009; 23: 1641-1643
    Search in Google Scholar
  • 9 Gamal WM, Hussein M, Aldahshoury M. et al. Solo ultrasonography-guided percutanous nephrolithotomy for single stone pelvis. J Endourol 2011; 25: 593-596
    Search in Google Scholar
  • 10 Ritter M, Rassweiler M-C, Michel MS. The Uro Dyna-CT Enables Three-dimensional Planned Laser-guided Complex Punctures. Eur Urol 2015; 68: 880-884
    Search in Google Scholar
  • 11 Thanos L, Mylona S, Stroumpouli E. et al. Percutaneous CT-guided nephrostomy: a safe and quick alternative method in management of obstructive and nonobstructive uropathy. J Endourol 2006; 20: 486-490
    Search in Google Scholar
  • 12 Rassweiler-Seyfried MC, Rassweiler JJ, Weiss C. et al. iPad-assisted percutaneous nephrolithotomy (PCNL): a matched pair analysis compared to standard PCNL. World J Urol 2020; 38: 447-453
    Search in Google Scholar
  • 13 Kariniemi J, Sequeiros RB, Ojala R, Tervonen O. MRI-guided percutaneous nephrostomy: a feasibility study. Eur Radiol 2009; 19: 1296-1301
    Search in Google Scholar
  • 14 Porsch M, Wendler JJ, Fischbach F. et al. [Placement of percutaneous nephrostomy by open magnetic resonance imaging: clinical results and current status in urology]. Urol Ausg A 2012; 51: 1722-1727
    Search in Google Scholar
  • 15 Pollock R, Mozer P, Guzzo TJ. et al. Prospects in percutaneous ablative targeting: Comparison of a computer-assisted navigation system and the AcuBot robotic system. J Endourol 2010; 24: 1269-1272
    Search in Google Scholar
  • 16 Lima E, Rodrigues PL, Mota P. et al. Ureteroscopy-assisted Percutaneous Kidney Access Made Easy: First Clinical Experience with a Novel Navigation System Using Electromagnetic Guidance (IDEAL Stage 1). Eur Urol 2017; 72: 610-616
    Search in Google Scholar
  • 17 Papatsoris AG, Shaikh T, Patel D. et al. Use of a virtual reality simulator to improve percutaneous renal access skills: a prospective study in urology trainees. Urol Int 2012; 89: 185-190
    Search in Google Scholar
  • 18 Kawahara T, Ito H, Terao H. et al. Ureteroscopy assisted retrograde nephrostomy: a new technique for percutaneous nephrolithotomy (PCNL). BJU Int 2012; 110: 588-590
    Search in Google Scholar
  • 19 Patel U, Hussain FF. Percutaneous nephrostomy of nondilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology 2004; 233: 226-233
    Search in Google Scholar
  • 20 Chau HL, Chan HCW, Li TBT. et al. 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. J Endourol 2016; 30: 160-164
    Search in Google Scholar
  • 21 Nouralizadeh A, Sharifiaghdas F, Pakmanesh H. et al. Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients: a single-center experience. World J Urol 2018; 36: 667-671
    Search in Google Scholar
  • 22 Klein J-T, Rassweiler J, Rassweiler-Seyfried M-C. Validation of a Novel Cost Effective Easy to Produce and Durable In Vitro Model for Kidney-Puncture and Percutaneous Nephrolitholapaxy-Simulation. J Endourol 2018; 32: 871-876
    Search in Google Scholar
  • 23 Kåsine T, Romundstad L, Rosseland LA. et al. Needle tip tracking for ultrasound-guided peripheral nerve block procedures-An observer blinded, randomised, controlled, crossover study on a phantom model. Acta Anaesthesiol Scand 2019; 63: 1055-1062
    Search in Google Scholar
  • 24 Degirmenci T, Gunlusoy B, Kozacioglu Z. et al. Utilization of a modified Clavien Classification System in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines. Urology 2013; 81: 1161-1167
    Search in Google Scholar
  • 25 Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol Stockh Swed 1987 2004; 45: 184-188
    Search in Google Scholar
  • 26 Rana AM, Zaidi Z, El-Khalid S. Single-center review of fluoroscopy-guided percutaneous nephrostomy performed by urologic surgeons. J Endourol 2007; 21: 688-691
    Search in Google Scholar
  • 27 Skolarikos A, Alivizatos G, Papatsoris A. et al. Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology 2006; 68: 495-499
    Search in Google Scholar
  • 28 Wollin DA, Preminger GM. Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis 2018; 46: 87-97
    Search in Google Scholar
  • 29 Sampaio FJ, Pereira-Sampaio MA, Favorito LA. The pig kidney as an endourologic model: anatomic contribution. J Endourol 1998; 12: 45-50
    Search in Google Scholar
  • 30 Huber J, Wegner I, Meinzer H-P. et al. Navigated renal access using electromagnetic tracking: an initial experience. Surg Endosc 2011; 25: 1307-1312
    Search in Google Scholar
  • 31 Hohmann M. Visuell navigierte, ultraschallgeführte Freihandpunktion des Nierenbeckenkelchsystems – Vereinfachung einer komplexen, urologischen Intervention – Präklinische Bewertung einer Punktionstechnik unter Zuhilfenahme einer neuartigen Navigationsfunktion. Dissertation, Universität Ulm 2024; 79: 944-8
    Search in Google Scholar