Mp73-01 Can Pulsed Fluoroscopy Be Used for Obtaining Renal Access? Feasibility and Comparison of Two Techniques

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment (MP73)1 May 2024MP73-01 CAN PULSED FLUOROSCOPY BE USED FOR OBTAINING RENAL ACCESS? FEASIBILITY AND COMPARISON OF TWO TECHNIQUES Tyler Humphries, Ala'a Farkouh, Matthew Buell, Akin S. Amasyali, Rose Leu, Kanha Shete, Katya Hanessian, Sikai Song, Kai Wen Cheng, Evan Seibly, Zhamshid Okhunov, and D. Duane Baldwin Tyler HumphriesTyler Humphries , Ala'a FarkouhAla'a Farkouh , Matthew BuellMatthew Buell , Akin S. AmasyaliAkin S. Amasyali , Rose LeuRose Leu , Kanha SheteKanha Shete , Katya HanessianKatya Hanessian , Sikai SongSikai Song , Kai Wen ChengKai Wen Cheng , Evan SeiblyEvan Seibly , Zhamshid OkhunovZhamshid Okhunov , and D. Duane BaldwinD. Duane Baldwin View All Author Informationhttps://doi.org/10.1097/01.JU.0001009564.26544.1c.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During percutaneous nephrolithotomy (PCNL), access is most frequently achieved using fluoroscopy, subjecting both patients and surgeons to radiation exposure. Recently, pulsed fluoroscopy has been employed to some portions of PCNL, however renal access is traditionally performed using continuous fluoroscopy. The purpose of this study was to compare two different techniques for renal access using low dose, pulsed fluoroscopy in a benchtop model. METHODS: A renal access model was created with a 12th rib and a target positioned in the upper calyx (Figure 1A). Ten urology attendings/trainees and ten medical students participated in a prospective, randomized, cross-over, benchtop study using two low dose, pulsed fluoroscopy techniques. In all trials, the low dose button was selected and combined with pulsed fluoroscopy at 1 pulse per second. In the first technique (Figure 1B), an 18-gauge needle was held using a metal clamp and inserted using a conventional bullseye method. In the second technique (Figure 1C & 1D), a laser beam from the image intensifier was used to guide insertion of a specialized needle, using a low-density handle. Fluoroscopy time, radiation dose, renal access time, and total number of attempts were recorded. Participants then rated the difficulty (1-10, 10 being most difficult) and satisfaction with each technique. Paired comparisons were conducted using Wilcoxon signed-rank test. RESULTS: Both low dose, pulsed fluoroscopy techniques had high success rates with 95% for laser-guided and 85% for conventional after 3 trials (p=0.29). The mean fluoroscopy time for the laser technique was 44% lower than the conventional needle (4.1 vs 7.3 sec; p=0.043). Even at the lowest fluoroscopy settings, the average radiation used was significantly higher when using the conventional needle compared to the laser-guided needle (1.5 vs 0.81 mGy; p=0.04). Access was rated to be significantly easier using the laser-guided technique vs the conventional needle (4.6 vs 6.6/10; p=0.021). 80% of participants preferred the laser-guided technique to establish renal access. CONCLUSIONS: Although challenging, pulsed low dose fluoroscopy can be used for establishing renal access during PCNL. Addition of a specialized laser-guided needle further reduces fluoroscopy time and simplifies the procedure. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1181 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Tyler Humphries More articles by this author Ala'a Farkouh More articles by this author Matthew Buell More articles by this author Akin S. Amasyali More articles by this author Rose Leu More articles by this author Kanha Shete More articles by this author Katya Hanessian More articles by this author Sikai Song More articles by this author Kai Wen Cheng More articles by this author Evan Seibly More articles by this author Zhamshid Okhunov More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...