Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
World J Urol. 2024 Mar 20;42(1):181. doi: 10.1007/s00345-024-04870-0.
This study assessed the feasibility of acquiring single-attempt access to the pelvicalyceal system during percutaneous nephrolithotomy (PCNL) using stereotactic optical navigation combined with cone-beam CT (CBCT) imaging.
Patients with a PCNL indication were prospectively included in this IRB approved study. After sterile preparation, fiducial markers were attached to patients' skin. An initial intraprocedural CBCT scan was acquired, on which the urologist planned the needle trajectory using the navigation software. After verifying that no critical structures were crossed, the needle guide was aligned with the plan. A needle was manually inserted through the needle guide to the indicated depth and a second CBCT scan was performed for needle position confirmation. Both, scanning and needle insertion, were performed under apnea. The study evaluated technical success, accuracy, procedure time, complication rate, and radiation dose.
Between June 2022 and April 2023, seven patients were included. In all patients, the navigation system allowed safe puncture. However, the technical success rate was only 29%. In 42% of the cases, pelvicalyceal access was achieved by a small manual adjustment. In the remaining 29%, the needle was retracted and positioned per clinical standard. The average deviation between the needle and target was 5.9 ± 2.3 mm. The average total procedure time was 211 ± 44 min. The average radiation exposure was 6.4 mSv, with CBCT scanning contributing to 82% of this exposure.
The optical navigation system facilitated safe needle insertion but did not consistently ensure accurate one-attempt needle positioning for PCNL. Real-time visualization and trajectory correction may improve the technical success rate.
本研究评估了立体光学导航结合锥形束 CT（CBCT）成像在经皮肾镜取石术（PCNL）中单次尝试进入肾盂系统的可行性。
本研究前瞻性纳入了有 PCNL 适应证的患者。在无菌准备后，在患者皮肤上贴上基准标记物。首先进行一次术中 CBCT 扫描，泌尿科医生在导航软件上根据该扫描制定针道计划。在确认没有穿过关键结构后，将针导器与计划对齐。手动将针通过针导器插入到指定深度，然后进行第二次 CBCT 扫描以确认针的位置。扫描和插入针均在屏气下进行。该研究评估了技术成功率、准确性、手术时间、并发症发生率和辐射剂量。
在 2022 年 6 月至 2023 年 4 月期间，共纳入 7 名患者。在所有患者中，导航系统均允许安全穿刺。然而，技术成功率仅为 29%。在 42%的病例中，通过小的手动调整实现了肾盂进入。在其余 29%的病例中，根据临床标准将针撤回并重新定位。针与目标之间的平均偏差为 5.9±2.3mm。平均总手术时间为 211±44 分钟。平均辐射暴露量为 6.4mSv，其中 CBCT 扫描占 82%。
光学导航系统有助于安全插入针，但不能始终确保 PCNL 中一次性准确的一针定位。实时可视化和轨迹修正可能会提高技术成功率。
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