Application of two percutaneous renal calyx puncture methods under real-time ultrasound guidance based on electromagnetic tracking and surgical navigation system

doi:10.3877/cma.j.issn.1674-3253.2024.06.007

Abstract

Abstract:

Objective

To introduce the application of real-time ultrasound-guided the outof-plane and the in-plane percutaneous renal calyx puncture techniques based on electromagnetic tracking and surgical navigation system.

Methods

35 cases of renal calculi undergoing percutaneous nephrolithotomy in Shenzhen Longgang District Sixth People's Hospital from September 2016 to July 2018 were analyzed. There were 25 males and 15 females，the median age of them was 44（29-70） years. BMI was 24.5（18.5-32.5） kg/m². Percutaneous nephrolithotomy was conducted by the SonixGPS^TM ultrasound equipment with electromagnetic tracking and navigation system produced by Ultrasonix of Canada. Under the guidance of electromagnetic tracking puncture needle，three-dimensional intraoperative navigation and real-time ultrasound guidance，two percutaneous calyceal puncture methods were used to establish the surgical channel by puncture the skin outside or inside the ultrasonic-image plane of ultrasonic transducer.According the different puncture methods，the cases were divided into two groups，20 cases in the outof-plane puncture group and 15 cases in the in-plane puncture group.

Results

The median successful time of puncture in the out-of-plane puncture group and the in-plane puncture group was 4.0（3.0-9.0）minutes and 6.0（3.0-18.0） minutes，respectively，and the difference was significant difference （P＜0.05）.The puncture success rates were 95.0%（19/20） and 93.3%（14/15），with no significance （P＞0.05）. Among the 35 cases，29 cases was achieved with the precise puncture effect of one-time puncture attempt and only 1 case had surgical complications with the highest grade of Clavien-Dindo classification Ⅲa.

Conclusion

The real-time ultrasound-guided the out-of-plane puncture method based on electromagnetic tracking and surgical navigation system has shorter puncture time and easier operation. When the intercostal space is not wide enough，the in-plane puncture method can still be used for precise puncture.

Key words: Renal stone, Percutaneous nephrostomy, Ultrasound, Electromagnetic tracking, Intraoperative navigation, Puncture

Bing Shi, Zhi Zhang, Jinhai Chen, Wen Tang. Application of two percutaneous renal calyx puncture methods under real-time ultrasound guidance based on electromagnetic tracking and surgical navigation system[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 572-578.

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Figures/Tables 6

References 28

［1］	饶婷，阮远，程帆. 超声引导下经 “肾盏穹隆-盏颈轴线” 两步穿刺法-PCNL通道建立的解剖学研究及临床应用［J］. 现代泌尿外科杂志，2021，26（3）: 185-188.Rao T，Ruan Y，Cheng F. Anatomical study and clinical application of ultrasound-guided two-step puncture through “calyceal domecalyceal axis”-PCNL channel establishment［J］. J Mod Urol，2021，26（3）: 185-188.
［2］	Hajiha M，Baldwin DD. New technologies to aid in percutaneous access［J］. Urol Clin North Am，2019，46（2）: 225-243.
［3］	Nguyen DD，Luo JW，Tailly T，et al. Percutaneous nephrolithotomy access: a systematic review of intraoperative assistive technologies［J］.J Endourol，2019，33（5）: 358-368.
［4］	He Z，Tang F，Lu Z，et al. Comparison of supracostal and infracostal access for percutaneous nephrolithotomy: a systematic review and meta-analysis［J］.Urol J，2019，16（2）:107-114.
［5］	Pulido-Contreras E，Garcia-Padilla MA，Medrano-Sanchez J，et al.Percutaneous nephrolithotomy with ultrasound-assisted puncture:does the technique reduce dependence on fluoroscopic ionizing radiation？［J］. World J Urol，2021，39（9）: 3579-3585.
［6］	Li R，Li T，Qian X，et al. Real-time ultrasonography-guided percutaneous nephrolithotomy using SonixGPS navigation: clinical experience and practice in a single center in China［J］. J Endourol，2015，29（2）: 158-161.
［7］	黄挺，程跃，谢国海，等. 超声引导下经皮肾镜取石术中穿刺成功率的临床研究［J］. 中华泌尿外科杂志，2019，40（12）: 923-926.Huang T，Cheng Y，Xie GH，et al. Clinical study of the puncture success rate during ultrasound-guided percutaneous nephrolithotomy［J］. Chin J Urol，2019，40（12）: 923-926.
［8］	张曦才，曹先德. 经皮肾镜取石术治疗无积水肾结石中皮肾通道建立的应用研究进展［J/OL］. 中华临床医师杂志（电子版），2023，17（8）: 911-915.Zhang XC，Cao XD. Progress in establishment of percutaneous renal tract in percutaneous nephrolithotomy for treatment of renal stones without hydronephrosis［J/OL］. Chin J Clinicians（Electronic Edition），2023，17（08）: 911-915.
［9］	Chau HL，Chan HC，Li TB，et al. An innovative free-hand puncture technique to reduce radiation in percutaneous nephrolithotomy using ultrasound with navigation system under magnetic field: a singlecenter experience in Hong Kong［J］. J Endourol，2016，30（2）: 160-164.
［10］	Li X，Long Q，Chen X，et al. Assessment of the SonixGPS system for its application in real-time ultrasonography navigation-guided percutaneous nephrolithotomy for the treatment of complex kidney stones［J］. Urolithiasis，2017，45（2）: 221-227.
［11］	Tefekli A，Ali Karadag M，Tepeler K，et al. Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard［J］. Eur Urol，2008，53（1）: 184-190.
［12］	Chu C，Masic S，Usawachintachit M，et al. Ultrasound-guided renal access for percutaneous nephrolithotomy: a description of three novel ultrasound-guided needle techniques［J］. J Endourol，2016，30（2）:153-158.
［13］	李翔，龙清志，陈兴发，等. 超声实时定位技术在经皮肾镜碎石术治疗肾盏无明显扩张肾结石中的应用［J］. 现代泌尿外科杂志，2016，21（8）: 589-592.Li X，Long QZ，Chen XF，et al. The clinical use of real time poisoning technology in PCNL for treating kidney stone patients with no obvious target renal calyx dilation［J］. J Mod Urol，2016，21（8）:589-592.
［14］	肖博，李建兴，胡卫国，等. 针状肾镜治疗上尿路结石的初步应用经验［J］. 中华泌尿外科杂志，2019，40（2）: 96-99.Xiao B，Li JX，Hu WG，et al. The initial clinical application of needle-perc in upper urinary tract stones［J］. Chin J Urol，2019，40（2）:96-99.
［15］	刘增钦，赵楚标，肖克峰. 非血管超声造影与常规超声辅助经皮肾镜取石术治疗无明显积水肾结石的前瞻性随机对照研究［J］. 中华泌尿外科杂志，2021，42（5）: 326-331.Liu ZQ，Zhao CB，Xiao KF. A randomized controlled study of nonvascular contrast-enhanced ultrasound and conventional ultrasoundassisted percutaneous nephrolithotomy in the treatment of renal calculi with no apparent hydronephrosis［J］. Chin J Urol，2021，42（5）:326-331.
［16］	Ritter M，Rassweiler MC，Michel MS. The uro dyna-CT enables three-dimensional planned laser-guided complex punctures［J］. Eur Urol，2015，68（5）: 880-884.
［17］	Lima E，Rodrigues PL，Mota P，et al. Ureteroscopy-assisted percutaneous kidney access made easy: first clinical experience with a novel navigation system using electromagnetic guidance （IDEAL stage 1）［J］. Eur Urol，2017，72（4）: 610-616.
［18］	Porpiglia F，Checcucci E，Amparore D，et al. Percutaneous kidney puncture with three-dimensional mixed-reality hologram guidance:from preoperative planning to intraoperative navigation［J］. Eur Urol，2022，81（6）: 588-597.
［19］	He XB，Liu YY，Huang GM，et al. The clinical application of puncture frame in establishing ultrasound guided percutaneous nephrolithotomy access［J］. J Urol，2020，17（4）: 358-362.
［20］	Tatanis V，Cracco CM，Liatsikos E. Advances in percutaneous renal puncture: a comprehensive review of the literature［J］. Curr Opin Urol，2023，33（2）: 116-121.
［21］	Brinkmann S，Tang R，Sawka A，et al. Single-operator real-time ultrasound-guided spinal injection using SonixGPS™: a case series［J］. Can J Anesth Can D'anesthésie，2013，60（9）: 896-901.
［22］	Usawachintachit M，Masic S，Allen IE，et al. Adopting ultrasound guidance for prone percutaneous nephrolithotomy: evaluating the learning curve for the experienced surgeon［J］. J Endourol，2016，30（8）: 856-863.
［23］	Ng FC，Yam WL，Lim TYB，et al. Ultrasound-guided percutaneous nephrolithotomy: advantages and limitations［J］. Investig Clin Urol，2017，58（5）: 346-352.
［24］	Corrales M，Doizi S，Barghouthy Y，et al. Ultrasound or fluoroscopy for percutaneous nephrolithotomy access，is there really a difference？A review of literature［J］. J Endourol，2021，35（3）: 241-248.
［25］	Tzou DT，Tailly TO，Stern KL. Ultrasound-guided PCNL - why are we still performing exclusively fluoroscopic access？［J］. Curr Urol Rep，2023，24（7）: 335-343.
［26］	Iordache A，Baston C，Guler-Margaritis SS，et al. Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review［J］. Med Ultrason，2018，20（4）: 508-514.
［27］	Xu S，Ma L，Lin J，et al. Efficacy and safety of percutaneous renal biopsy performed using 18G needle versus 16G needle: a singlecenter retrospective study［J］. Int Urol Nephrol，2022，54（12）: 3255-3261.
［28］	Borofsky MS，Rivera ME，Dauw CA，et al. Electromagnetic guided percutaneous renal access outcomes among surgeons and trainees of different experience levels: a pilot study［J］. Urology，2020，136: 266-271.

组别	例数	性别［例（%）］		年龄［岁，M（R）］	体质量指数［kg/m²，M（R）］	肾结石受累侧别［例（%）］		肾集合系统分离宽度［cm，M（R）］	结石大小［cm，M（R）］
组别	例数	男	女	年龄［岁，M（R）］	体质量指数［kg/m²，M（R）］	左侧	右侧	肾集合系统分离宽度［cm，M（R）］	结石大小［cm，M（R）］
平面外穿刺组	20	11（55.0）	9（45.0）	44（29～70）	24.6（18.5～32.5）	12（60.0）	8（40.0）	2.3（0～4.5）	2.3（1.7～5.5）
平面内穿刺组	15	14（93.3）	1（6.7）	44（30～60）	22.7（19.6～31.2）	7（46.7）	8（53.3）	1.7（0～7.0）	2.7（1.6～5.3）
P值		0.022		0.452	0.764	0.506		0.973	0.050

组别	例数	性别［例（%）］		年龄［岁，M（R）］	体质量指数［kg/m²，M（R）］	肾结石受累侧别［例（%）］		肾集合系统分离宽度［cm，M（R）］	结石大小［cm，M（R）］
组别	例数	男	女	年龄［岁，M（R）］	体质量指数［kg/m²，M（R）］	左侧	右侧	肾集合系统分离宽度［cm，M（R）］	结石大小［cm，M（R）］
平面外穿刺组	20	11（55.0）	9（45.0）	44（29～70）	24.6（18.5～32.5）	12（60.0）	8（40.0）	2.3（0～4.5）	2.3（1.7～5.5）
平面内穿刺组	15	14（93.3）	1（6.7）	44（30～60）	22.7（19.6～31.2）	7（46.7）	8（53.3）	1.7（0～7.0）	2.7（1.6～5.3）
P值		0.022		0.452	0.764	0.506		0.973	0.050

组别	例数	经皮肾盏穿刺时间［min，M（R）］	经皮肾盏穿刺情况［例（%）］
组别	例数	经皮肾盏穿刺时间［min，M（R）］	一次穿刺成功	不超过三次尝试穿刺成功	三次以上尝试穿刺失败
平面外穿刺组	20	4.0（3.0～9.0）	17（85.0）	2（10.0）	1（5.0）
平面内穿刺组	15	6.0（3.0～18.0）	12（80.0）	2（13.3）	1（6.7）
P值		0.013		＞0.999

组别	例数	经皮肾盏穿刺时间［min，M（R）］	经皮肾盏穿刺情况［例（%）］
组别	例数	经皮肾盏穿刺时间［min，M（R）］	一次穿刺成功	不超过三次尝试穿刺成功	三次以上尝试穿刺失败
平面外穿刺组	20	4.0（3.0～9.0）	17（85.0）	2（10.0）	1（5.0）
平面内穿刺组	15	6.0（3.0～18.0）	12（80.0）	2（13.3）	1（6.7）
P值		0.013		＞0.999

项目	平面外穿刺方法	平面内穿刺方法
穿刺针在探头的位置	穿刺针在探头横向一侧中心，穿刺点与探头轴向距离1.2cm，与目标肾盏距离近	穿刺针在探头纵向一端中心，穿刺点与探头轴向距离3.7cm，与目标肾盏距离远
穿刺方式对肋间隙宽度的要求	肋间隙足够容纳探头的宽度，必须大于探头横向宽度24mm	对肋间隙宽度要求可以小一些，必须不小于探头横向宽度24mm
穿刺要点	穿刺针沿穿刺路径引导的方向，直接穿刺到目标盏，不受与超声图像保持同平面的限制	穿刺针被引导穿刺的同时，必须始终保持和调整进针方向，受到与超声图像保持同平面的限制
穿刺操作的难度	穿刺更省时，操作更容易	穿刺受到保持同平面的限制，难度稍大
穿刺方式的选择	是首选穿刺方式，但是受肋间隙宽度限制	在肋间隙不足够宽时仍能进行精准穿刺

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