(UroToday.com) Dr. Kazumi Taguchi, an associate professor from Nagoya, Japan, unveiled an innovative study delving into the efficacy of a robotic platform for establishing access to the renal system during Percutaneous Nephrolithotomy (PCNL). Building upon prior research demonstrating the effectiveness of robot-assisted fluoroscopy-guided (RAG) puncture in the prone position, Dr. Taguchi's presentation underscored the critical role of renal puncture access tract establishment in surgical outcomes, thereby minimizing patient risk.
Current literature indicates that acquiring proficiency in renal puncture necessitates extensive training—typically between 60 to 106 cases—Dr. Taguchi and his team embarked on a novel approach. They utilized the ANT-X robot-assisted platform, employing triangulation targeting, to evaluate renal puncture tract establishment in the supine position. This prospective multi-institutional study, following IRB approval, enrolled patients with large renal stones.
During procedures, the ANT-X targeting system was strategically positioned lateral to the patient's flank in the supine position, as illustrated in Figure 1-A. Artificial hydronephrosis induction by the ureteroscope enhanced calyx visualization. Clinical engineers leveraged the ANT-X targeting system to plan trajectories for renal system puncture, aiming for precise tract establishment.
Among the participating institutions, a total of 21 cases were completed, with reported stone volume and density measuring 5057 mm3 and 1353 HU, respectively. Three months post-operation, the stone-free rate stood at 85%. Notably, robot-assisted fluoroscopy-guided (RAG) procedures with ANT-X proved successful in 17 cases, while 4 necessitated ultrasound guidance due to software limitations in trajectory and puncture angle adjustments.
Analysis revealed significant disparities in various parameters between the groups utilizing ultrasound guidance and those relying solely on RAG. These differences encompassed the diameter of the selected calyx, the number of punctures, the time required for robotic puncture, and the user's learning curve.
Surgeons' experience level with RAG and ANT-X were pivotal, with a steep learning curve observed, particularly correlated with the diameter of the selected calyx (Figure 2). Ultimately, while RAG in supine PCNL demonstrates feasibility despite its demanding learning curve, targeting small calyces remains an ongoing challenge.
In the engaging question-and-answer session following the presentation, a participant posed a query about the total fluoroscopy time. Dr. Kazumi Taguchi's response shed light on the intricacies of the puncture procedure, revealing that quantifying fluoroscopy time during the process posed challenges—an acknowledgment that piqued the curiosity of attendees.
The dialogue delved deeper into the discussion, as the moderator probed whether the fluoroscopy time was lower than that of conventional PCNL tract establishment. The presenter's elucidation on their institution's standard care approach, involving PCNL and puncture conducted under ultrasound guidance, provided valuable insight and sparked further interest among the audience.
Presented by: Kazumi Taguchi, Associate Professor of Nephro-Urology Nagoya City University, Japan.
Written by: Seyedamirvala Saadat, B.S., Assistant Research Specialist, Department of Urology, University of California Irvine, @Val_Saadat on X during the 2024 American Urological Association (AUA) Annual Meeting, May 2nd – 6th, 2024, San Antonio, Texas.