Pd22-06 Evaluating the Efficacy of Robot-Assisted Fluoroscopic Renal Puncture in the Supine Position: A Global Multicenter First-in-Human Trial

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD22)1 May 2024PD22-06 EVALUATING THE EFFICACY OF ROBOT-ASSISTED FLUOROSCOPIC RENAL PUNCTURE IN THE SUPINE POSITION: A GLOBAL MULTICENTER FIRST-IN-HUMAN TRIAL Kazumi Taguchi, Shuzo Hamamoto, Shimpei Yamashita, Kengo Kawase, Teruaki Sugino, Yohei Takakura, Rei Unno, Chinnakhet Ketsuwan, and Takahiro Yasui Kazumi TaguchiKazumi Taguchi , Shuzo HamamotoShuzo Hamamoto , Shimpei YamashitaShimpei Yamashita , Kengo KawaseKengo Kawase , Teruaki SuginoTeruaki Sugino , Yohei TakakuraYohei Takakura , Rei UnnoRei Unno , Chinnakhet KetsuwanChinnakhet Ketsuwan , and Takahiro YasuiTakahiro Yasui View All Author Informationhttps://doi.org/10.1097/01.JU.0001009504.18450.e0.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Technological innovations in endoscopic devices are advancing, yet achieving renal access during percutaneous nephrolithotomy (PCNL) remains a critical step for success. We have previously reported the efficacy of robot-assisted fluoroscopy-guided (RAG) puncture in the prone position. To enhance clinical utility through improved auto-trajectory navigation, we developed an advanced robotic system (ANT-X®) employing a triangulation method. This study presents a multicenter prospective evaluation of RAG renal access in supine PCNL. METHODS: We conducted this multicenter prospective study across various Asian countries. Patients with large renal stones requiring PCNL were recruited in accordance with IRB. The ANT-X was positioned laterally to the patient's flank while supine for percutaneous access (Figure 1). A ureteroscope induced artificial hydronephrosis to visualize the target calyx, after which imaging and software controlled by clinical engineers provided an optimal trajectory for puncture. The needle puncture and subsequent PCNL procedures were performed by a lead surgeon at each site. RESULTS: Seventeen mini-PCNL with ureterosopic assistance were completed across the academic centers. Median stone volume and density were 6.0 cm3 and 1311 HU, respectively, with an 88% stone-free rate and no major complications. RAG with ANT-X was successful in thirteen cases, while four required ultrasound guidance due to software limitations in adjusting the puncture angle. Failures were associated with a smaller calyx diameter (7.5 mm vs. 15 mm, p=0.012) and longer imaging and puncture times (42.5 min vs. 12 min, p=0.005). In successful cases, the median number of needle punctures for access was one, with a median total surgical time of 107 minutes. A steep learning curve was observed, suggesting a potential correlation with the diameter of the targeted renal calyx (Figure 2). CONCLUSIONS: RAG in supine PCNL is feasible with steep learning curve; however, targeting small calyces remains challenging. Download PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e462 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kazumi Taguchi More articles by this author Shuzo Hamamoto More articles by this author Shimpei Yamashita More articles by this author Kengo Kawase More articles by this author Teruaki Sugino More articles by this author Yohei Takakura More articles by this author Rei Unno More articles by this author Chinnakhet Ketsuwan More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement PDF downloadLoading ...