Oliveira-Santos Thiago, Peterhans Matthias, Roth Beat, Reyes Mauricio, Nolte Lutz-Peter, Thalmann George, Weber Stefan
Institute for Surgical Technology & Biomechanics, Bern University, Bern, Switzerland.
Annu Int Conf IEEE Eng Med Biol Soc. 2010;2010:442-5. doi: 10.1109/IEMBS.2010.5627387.
Percutaneous nephrolithotomy (PCNL) for the treatment of renal stones and other related renal diseases has proved its efficacy and has stood the test of time compared with open surgical methods and extracorporeal shock wave lithotripsy. However, access to the collecting system of the kidney is not easy because the available intra-operative image modalities only provide a two dimensional view of the surgical scenario. With this lack of visual information, several punctures are often necessary which, increases the risk of renal bleeding, splanchnic, vascular or pulmonary injury, or damage to the collecting system which sometimes makes the continuation of the procedure impossible. In order to address this problem, this paper proposes a workflow for introduction of a stereotactic needle guidance system for PCNL procedures. An analysis of the imposed clinical requirements, and a instrument guidance approach to provide the physician with a more intuitive planning and visual guidance to access the collecting system of the kidney are presented.
经皮肾镜取石术（PCNL）用于治疗肾结石及其他相关肾脏疾病，与开放手术方法和体外冲击波碎石术相比，已证明其有效性且经受住了时间的考验。然而，进入肾脏集合系统并不容易，因为现有的术中成像方式仅提供手术场景的二维视图。由于缺乏这种视觉信息，通常需要多次穿刺，这增加了肾出血、内脏、血管或肺部损伤的风险，或者对集合系统造成损伤，有时甚至使手术无法继续进行。为了解决这个问题，本文提出了一种在PCNL手术中引入立体定向针引导系统的工作流程。文中还分析了临床需求，并提出了一种器械引导方法，为医生提供更直观的规划和视觉引导，以进入肾脏集合系统。
