A hypothetical method for calculation of the access point, direction angle and access angle for percutaneous nephrolithotomy

An algorithm for cognitive fusion targeted tumor puncture based on 3-D mathematical modelling

Background

Percutaneous puncture is an important means of tumor diagnosis and treatment. At present, most puncture operations are still based on imaging location and clinical experience, and quantitative and accurate targeted puncture cannot be achieved. How to improve the accuracy of percutaneous tumor puncture, avoid errors to the greatest extent, reduce the occurrence of complications, and improve the overall clinical diagnosis and treatment quality and curative effect, are scientific problems worthy of further study.

Method

In the present study, mathematical modeling was first used to construct the tumor puncture path, determine the needle entry angle, and define the relevant limited parameters and the substitution formula. Secondly, relevant parameters were extracted from CT and other imaging data and substituted into formulas, the deviation angle and puncture path were determined, and the personalized tumor puncture scheme was carried out. Third, targeted puncture was precisely implemented under the guidance of B-ultrasound. Compared with the traditional empirical puncture, our model improved the accuracy, decreased the puncture time, and reduced the pain of diagnosis and treatment for patients.

Results

A tumor-targeted puncture model was established based on mathematical theory and imaging data. By extracting clinical data, such as tumor radius, projection distance of tumor center and projection distance from puncture point to body surface, the optimal puncture deviation angle was modeled and calculated and a personalized puncture scheme was established. Compared with the conventional method, our model markedly increased the puncture accuracy rate by ∼30%. The puncture number was decreased by ∼50% using our model. Furthermore, our model shortened the operation time by 20% to ease pain of patients and guarantee greater security for patients. Doctor satisfaction and patient discomfort scores were examined. Our model improved doctor satisfaction by ∼20% and reduced subjective discomfort of patients by ∼25%. These data revealed that the model could markedly improve the accuracy and efficiency of puncture, clinical efficacy and accuracy of tumor diagnosis. Additionally, the confidence of doctors in the operation was greatly enhanced and patient discomfort was greatly reduced.

Conclusion

The present study analyzed in detail how to find the best puncture path using a mathematical model. Based on the mathematical model of cognitive fusion puncture, combined with clinical personalized data and mathematical calculation analysis, accurate puncture was effectively realized. It not only greatly improved the effectiveness of puncture, but also ensured the safety of clinical patients and reduced injury, which means it may be worthy of clinical application.

Application of a novel computer-assisted surgery system in percutaneous nephrolithotomy: A controlled study

BACKGROUND

Most complex renal stones are managed primarily with percutaneous nephrolithotomy (PCNL). However, PCNL is still a great challenge for surgeons because of poor comprehension on complex adjacent structures. Novel techniques are required to assist in planning and navigation.

AIM

To apply and evaluate the Hisense computer-assisted surgery (CAS) system in PCNL.

METHODS

A total of 60 patients with complex renal stones were included. Thirty patients in the CAS group had three-dimensional (3D) virtual models constructed with the CAS system. The model assisted in planning and navigating in the CAS system. Thirty patients in the control group planned and navigated as standard PCNL, without the application of the CAS system. Success rate of one attempt, operation time, initial stone-free rate, decrease in hemoglobin, and complications were collected and analyzed.

RESULTS

There were no statistically significant differences in the baseline characteristics or planning characteristics. The success rate of one puncturing attempt (90% vs 67%, P = 0.028) and the initial stone-free rate (87% vs 63%, P = 0.037) were significantly higher in the CAS group. However, there were no statistically significant differences in the operation time (89.20 ± 29.60 min vs 92.33 ± 33.08 min, P = 0.859) or in the decrease in hemoglobin (11.07 ± 8.32 g/L vs 9.03 ± 11.72 g/L, P = 0.300) between the CAS group and the control group. No statistically significant differences in the incidence of complications (Clavien-Dindo grade ≥ 2) were found.

CONCLUSION

Compared with standard PCNL, CAS-assisted PCNL had advantages in terms of the puncturing success rate and stone-free rate. The Hisense CAS System was recommended to assist in preoperative planning and intraoperative navigation for an intuitive, precise and convenient PCNL.

Percutaneous Kidney Puncture with Three-dimensional Mixed-reality Hologram Guidance: From Preoperative Planning to Intraoperative Navigation

BACKGROUND

Despite technical and technological innovations, percutaneous puncture still represents the most challenging step when performing percutaneous nephrolithotomy. This maneuver is characterized by the steepest learning curve and a risk of injuring surrounding organs and kidney damage.

OBJECTIVE

To evaluate the feasibility of three-dimensional mixed reality (3D MR) holograms in establishing the access point and guiding the needle during percutaneous kidney puncture.

DESIGN, SETTING, AND PARTICIPANTS

This prospective study included ten patients who underwent 3D MR endoscopic combined intrarenal surgery (ECIRS) for kidney stones from July 2019 to January 2020. A retrospective series of patients who underwent a standard procedure were selected for matched pair analysis.

SURGICAL PROCEDURE

For patients who underwent 3D MR ECIRS, holograms were overlapped on the real anatomy to guide the surgeon during percutaneous puncture. In the standard group, the procedures were only guided by ultrasound and fluoroscopy.

MEASUREMENTS

Differences in preoperative and postoperative patient characteristics between the groups were tested using a χ² test and a Kruskal-Wallis test for categorical and continuous variables, respectively. Results are reported as the median and interquartile range for continuous variables and as the frequency and percentage for categorical variables.

RESULTS AND LIMITATIONS

Ten patients underwent 3D MR ECIRS. In all cases, the inferior calyx was punctured correctly, as planned using the overlapping hologram. The median puncture and radiation exposure times were 27 min and 120 s, respectively. No intraoperative or major postoperative complications occurred. Matched pair analysis with the standard ECIRS group revealed a significantly shorter radiation exposure time for the 3D MR group (p < 0.001) even though the puncture time was longer in comparison to the standard group (p < 0.001). Finally, use of 3D MR led to a higher success rate for renal puncture at the first attempt (100% vs 50%; p = 0.032). The main limitations of the study are the small sample size and manual overlapping of the rigid hologram models.

CONCLUSIONS

Our experience demonstrates that 3D MR guidance for renal puncture is feasible and safe. The procedure proved to be effective, with the inferior calyx correctly punctured in all cases, and was associated with a low intraoperative radiation exposure time because of the MR guidance.

PATIENT SUMMARY

Three-dimensional virtual models visualized as holograms and intraoperatively overlapped on the patient's real anatomy seem to be a valid new tool for guiding puncture of the kidney through the skin for minimally invasive treatment.

Techniques for fluoroscopy-guided percutaneous renal access: An analytical review

Percutaneous renal access is a key step for a successful percutaneous nephrolithotomy. It involves the use of fluoroscopy, ultrasonography, or a combination of both. Over the years, various techniques have been proposed for fluoroscopy-guided access, and this article reviews the different techniques along with the anatomical principles for fluoroscopy-guided percutaneous renal access. A literature search was performed using "PubMed" for relevant literature describing the various techniques for fluoroscopy-guided percutaneous renal access. Each technique was analyzed in regard to how it describes selecting the skin site for puncture and determines the angle and depth of puncture. The advantages, limitations, and variations of these techniques were also studied. Each technique has its advantages and limitations. No study has compared all the techniques either in vivo or in vitro. Only a comparative study would establish the superiority of one technique over the other. Until this is done, endourologists should be well versed with the existing techniques.