Natsos Anastasios, Tsaturyan Arman, Peteinaris Angelis, Adamou Constantinos, Pagonis Konstantinos, Bravou Vasiliki, Koumoundourou Dimitra, Vrettos Theofanis, Kagadis George, Giannitsas Konstantinos, Kallidonis Panagiotis, Liatsikos Evangelos
Department of Urology, University Hospital of Patras, Patras, Greece.
Department of Pathology, University Hospital of Patras, Patras, Greece.
J Endourol. 2023 Jan;37(1):15-20. doi: 10.1089/end.2022.0322. Epub 2022 Dec 12.
To evaluate the clearance of metal particles produced and released in the pelvicaliceal system (PCS) during percutaneous nephrolithotomy (PCNL) with the use of the Swiss Lithoclast Trilogy dual-energy (EMS Urology, Nyon, Switzerland) lithotripter. An experimental study and a clinical investigation of case series were conducted. An porcine model with two pigs for lithotripsy (after inserting artificial stones into the collecting system) and two pigs for submucosal injection of metal particles (provided by the manufacturer of Trilogy) was conducted. Porcine kidney histology analysis for metal leftovers was conducted immediately or 2 weeks after the surgery. A prospective observational study design included 10 consecutive patients treated with conventional 30F PCNL or with 22F mini-PCNL technique. Only the patients with the confirmed metal particles in the PCS during the initial PCNL and the need for additional retrograde intrarenal surgery over a period of 2-4 weeks were selected. The presence of metal particles was evaluated during the second endoscopic surgery. The generated metal particles during PCNL and the submucosally injected particles were not found macroscopically 2 weeks postoperatively in porcine models. No pathologic changes such as foreign body granuloma or inflammation were found. Similarly, no metal particles were observed during the second look endoscopy ( = 10). Metal particles observed endoscopically using the Trilogy lithotripter are cleared with no pathologic evidence of tissue damage from the metal particles 2 weeks after the procedure. Thus, the intraoperative release of any particle by the Trilogy lithotripter should not raise any safety concerns.
使用瑞士碎石清石系统三代双能量（EMS Urology，瑞士尼翁）碎石机评估经皮肾镜取石术（PCNL）过程中肾盂肾盏系统（PCS）产生和释放的金属颗粒的清除情况。进行了一项实验研究和病例系列的临床调查。建立了一个猪模型，其中两头猪用于碎石术（在收集系统中插入人工结石后），两头猪用于黏膜下注射金属颗粒（由三代碎石机制造商提供）。在手术后立即或2周后对猪肾组织进行金属残留分析。一项前瞻性观察性研究设计纳入了10例连续接受传统30F PCNL或22F迷你PCNL技术治疗的患者。仅选择在初次PCNL期间PCS中确认有金属颗粒且在2至4周内需要额外进行逆行肾内手术的患者。在第二次内镜手术期间评估金属颗粒的存在情况。在猪模型中，术后2周肉眼未发现PCNL过程中产生的金属颗粒和黏膜下注射的颗粒。未发现异物肉芽肿或炎症等病理变化。同样，在二次内镜检查时（n = 10）未观察到金属颗粒。使用三代碎石机在内镜下观察到的金属颗粒在术后2周被清除，没有金属颗粒造成组织损伤的病理证据。因此，三代碎石机在术中释放的任何颗粒都不应引起任何安全担忧。
