Cadeddu J A, Stoianovici D, Chen R N, Moore R G, Kavoussi L R
The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA.
J Endourol. 1998 Apr;12(2):121-5. doi: 10.1089/end.1998.12.121.
Obtaining accurate percutaneous renal access when treating intrarenal disease requires substantial skill. Robotic devices have been used in a variety of surgical applications and have been successful in facilitating percutaneous puncture while improving accuracy. Laboratory models of robotic devices for percutaneous renal access have also been developed. However, several technical hurdles need to be addressed. One relates to the device-patient interface. As a first step in creating a complete robotic system, a mechanical arm (PAKY) with active translational motion for percutaneous renal access has been developed and clinically assessed. The PAKY consists of a passive mechanical arm mounted on the operating table and a radiolucent needle driver that uses a novel active translational mechanism for needle advancement. The system utilizes real-time fluoroscopic images provided by a C-arm to align and monitor active needle placement. In vitro experiments to test needle placement accuracy were conducted using a porcine kidney suspended in agarose gel. Seven copper balls 3 to 12.5 mm diameter were placed in the collecting system as targets, and successful access was confirmed by electrical contact with the ball. The PAKY was then used clinically in nine patients. The number of attempts, target calix location, calix size, and time elapsed were evaluated. In the in vitro study, successful needle-ball contact occurred the first time in all 70 attempts, including 10 attempts at the 3-mm balls. Clinically, percutaneous access to the desired calix was attained on the first attempt in each case. The mean target calix diameter was 14.7 mm (range 7-40 mm). The mean time elapsed while attempting access was 8.2 minutes. No perioperative complications attributable to needle access occurred. Early experience indicates that the PAKY provides a steady needle holder and an effective and safe end-effector for percutaneous renal access. This device may provide the mechanical platform for the development of a complete robotic system capable of creating percutaneous renal access.
治疗肾内疾病时获得准确的经皮肾穿刺通道需要相当高的技巧。机器人设备已应用于多种外科手术中，并成功地在提高准确性的同时促进了经皮穿刺。用于经皮肾穿刺通道的机器人设备的实验室模型也已开发出来。然而，有几个技术障碍需要解决。其中一个与设备-患者界面有关。作为创建完整机器人系统的第一步，已开发出一种具有主动平移运动的用于经皮肾穿刺通道的机械臂（PAKY）并进行了临床评估。PAKY由安装在手术台上的被动机械臂和使用新型主动平移机制推进针头的射线可透针驱动器组成。该系统利用C形臂提供的实时荧光透视图像来对准和监测针头的主动放置。使用悬浮在琼脂糖凝胶中的猪肾进行体外实验以测试针头放置的准确性。将7个直径为3至12.5毫米的铜球放置在收集系统中作为目标，并通过与球的电接触确认成功穿刺。然后PAKY在9名患者中进行了临床应用。评估了尝试次数、目标肾盏位置、肾盏大小和所用时间。在体外研究中，在所有70次尝试中首次尝试均成功实现了针与球的接触，包括对3毫米球的10次尝试。临床上，在每种情况下首次尝试均实现了对所需肾盏的经皮穿刺。平均目标肾盏直径为14.7毫米（范围为7至40毫米）。尝试穿刺所用的平均时间为8.2分钟。未发生因穿刺引起的围手术期并发症。早期经验表明，PAKY为经皮肾穿刺通道提供了稳定的持针器以及有效且安全的末端执行器。该设备可为开发能够创建经皮肾穿刺通道的完整机器人系统提供机械平台。
