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Bouchalakis A, Somani BK, Lima E, Rassweiler-Seyfried MC, Mamoulakis C, Tokas T. Navigation systems and 3D imaging in percutaneous nephrolithotripsy: improving outcomes and safety. Curr Opin Urol 2024; 34:105-109. [PMID: 37889519 DOI: 10.1097/mou.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Percutaneous nephrolithotripsy (PCNL) is the first-line management option for large kidney stones (>2 cm). It remains, however, a demanding procedure with considerable morbidity. The present narrative review summarizes recent knowledge from original research studies investigating navigation systems/three-dimensional (3D) imaging in PCNL, particularly on publications during the past 12-18 months. RECENT FINDINGS Navigation systems and 3D imaging are primarily used for preoperative planning, with few intra-operative applications. Patient management and residents' training could benefit from their use. SUMMARY Navigation systems and 3D imaging technology have emerged as a potential game-changer in PCNL. Even though available evidence is currently scarce/inconclusive, the safety/efficacy of navigation systems and 3D dimensional imaging use in PCNL appears promising. This advanced technology offers precise anatomical mapping, improved visualization, and surgical accuracy. Enabling a comprehensive preoperative evaluation and improving guidance, navigation systems, and 3D imaging technology may improve the safety and efficacy of PCNL. With continuous technological evolution, it is expected that improvements/innovations will offer further aid in such demanding procedures. Familiarization and cost reduction are necessary for widespread application, while larger-scale prospective studies and well designed randomized controlled trials are still needed.
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Affiliation(s)
- Athanasios Bouchalakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Estevao Lima
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho
- ICVS/3B's-PT, Government Associate Laboratory, Braga/Guimarães
- Deparment of Urology, Hospital of Braga, Braga, Portugal
| | | | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Theodoros Tokas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
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Kallidonis P, Peteinaris A, Tatanis V, Vagionis A, Faitatziadis S, Liatsikos E. Percutaneous nephrolithotomy non-papillary puncture trends. A review of the literature. Actas Urol Esp 2024; 48:52-56. [PMID: 37330051 DOI: 10.1016/j.acuroe.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/19/2023] [Indexed: 06/19/2023]
Abstract
Percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal calculi. Papillary puncture is the mainstay of treatment for large renal calculi, but the non-papillary has been introduced and gained some interest. The aim of this study is the investigation of trends of non-papillary access for PCNL over the years. A review of the literature took place and 13 publications were included in the study. Two experimental studies investigating the feasibility of non-papillary access were found. Five cohort prospective and 2 retrospective studies for non-papillary access and 4 comparative studies between papillary and non-papillary access were included. Non papillary access is a technique that has been proved as a safe and efficient solution that keeps up with the latest endoscopic trends. A wider use of this method could be expected in the future.
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Affiliation(s)
- P Kallidonis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece.
| | - A Peteinaris
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - V Tatanis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - A Vagionis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - S Faitatziadis
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece
| | - E Liatsikos
- Servicio de Urología, Hospital Universitario de Rion, Patras, Greece; Hospital Universitario de Viena, Viena, Austria
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Efthymiou FO, Metaxas VI, Dimitroukas CP, Delis HB, Zikou KD, Ntzanis ES, Zampakis PE, Panayiotakis GS, Kalogeropoulou CP. A retrospective survey to establish institutional diagnostic reference levels for CT urography examinations based on clinical indications: preliminary results. Biomed Phys Eng Express 2023; 9:065005. [PMID: 37651989 DOI: 10.1088/2057-1976/acf582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective. To establish institutional diagnostic reference levels (IDRLs) based on clinical indications (CIs) for three- and four-phase computed tomography urography (CTU).Methods. Volumetric computed tomography dose index (CTDIvol), dose-length product (DLP), patients' demographics, selected CIs like lithiasis, cancer, and other diseases, and protocols' parameters were retrospectively recorded for 198 CTUs conducted on a Toshiba Aquilion Prime 80 scanner. Patients were categorised based on CIs and number of phases. These groups' 75th percentiles of CTDIvoland DLP were proposed as IDRLs. The mean, median and IDRLs were compared with previously published values.Results. For the three-phase protocol, the CTDIvol(mGy) and DLP (mGy.cm) were 22.7/992 for the whole group, 23.4/992 for lithiasis, 22.8/1037 for cancer, and 21.2/981 for other diseases. The corresponding CTDIvol(mGy) and DLP (mGy.cm) values for the four-phase protocol were 28.6/1172, 30.6/1203, 27.3/1077, and 28.7/1252, respectively. A significant difference was found in CTDIvoland DLP between the two protocols, among the phases of three-phase (except cancer) and four-phase protocols (except DLP for other diseases), and in DLP between the second and third phases (except for cancer group). The results are comparable or lower than most studies published in the last decade.Conclusions. The CT technologist must be aware of the critical dose dependence on the scan length and the applied exposure parameters for each phase, according to the patient's clinical background and the corresponding imaging anatomy, which must have been properly targeted by the competent radiologist. When clinically feasible, restricting the number of phases to three instead of four could remarkably reduce the patient's radiation dose. CI-based IDRLs will serve as a baseline for comparison with CTU practice in other hospitals and could contribute to national DRL establishment. The awareness and knowledge of dose levels during CTU will prompt optimisation strategies in CT facilities.
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Affiliation(s)
- Fotios O Efthymiou
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Christos P Dimitroukas
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Harry B Delis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Kiriaki D Zikou
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
| | | | - Petros E Zampakis
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
| | - George S Panayiotakis
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece
- Department of Medical Physics, University Hospital of Patras, 26504 Patras, Greece
| | - Christina P Kalogeropoulou
- Department of Radiology, University Hospital of Patras, 26504 Patras, Greece
- Department of Radiology, School of Medicine, University of Patras, 26504 Patras, Greece
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Qi Y, Lin F, Li B, Han S, Yu W, Rao T, Zhou X, Ning J, Xiong Z, Cheng F. Classification and clinical significance of the posterior group of renal calyces. Medicine (Baltimore) 2023; 102:e34443. [PMID: 37543815 PMCID: PMC10402955 DOI: 10.1097/md.0000000000034443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
To study the anatomical orientation of the posterior group of calyces based on reconstructed images of computerized tomography urography (CTU) and provide a novel classification with its clinical significance. Clinical data of a total of 1321 patients, who underwent CTU examination in our hospital were retrospectively analyzed. Among these, a total of 2642 3-dimensional reconstructed images of CTU scans were considered in this study. Based on the morphology of the renal calyces and the influence on the establishment of surgical access, the posterior group renal calyces are classified into 3 major types including pot-belly type, classically branched and elongated branched. The classically branched type is further classified into 3 sub-types: a, b and c, based on the association of minor calyces of the posterior group to the major calyces. Type a is derived from 1 group of major calyces only, type b is derived from 2 groups of major calyces simultaneously, and type c is derived from 3 groups of major calyces simultaneously. Statistical findings revealed that all kidneys possess posterior group calyces. The percentage of occurrence of pot-belly type, classically branched and elongated branched is 8.06%, 73.13%, and 18.81%, respectively. The anatomical typing of the classical branching type occurred in 19.36%, 68.17%, and 12.47% for types a, b, and c, respectively. In this study, the posterior group calyces were found to be present across all patients. The posterior group calyces were highest in the classical branching type, of which anatomical typing was highest in type b. The typing of the posterior group of calyces could provide an anatomical basis for percutaneous nephrolithotomy (PCNL) puncture from the posterior group.
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Affiliation(s)
- Yucheng Qi
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Qin F, Sun YF, Wang XN, Li B, Zhang ZL, Zhang MX, Xie F, Liu SH, Wang ZJ, Cao YC, Jiao W. Application of a novel computer-assisted surgery system in percutaneous nephrolithotomy: A controlled study. World J Clin Cases 2022; 10:6039-6049. [PMID: 35949849 PMCID: PMC9254189 DOI: 10.12998/wjcc.v10.i18.6039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Fei Qin
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ye-Feng Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xin-Ning Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Bin Li
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Zhi-Lei Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ming-Xin Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Fei Xie
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Shuai-Hong Liu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Zi-Jie Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yuan-Chao Cao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wei Jiao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Armano G, Barbuto S, Wagner S, Carugno J, Bifulco G, Di Spiezio Sardo A. Incorporating 3D reconstruction in preoperative surgical planning of Multiple Myomectomy. Facts Views Vis Obgyn 2022; 14:87-89. [PMID: 35373553 PMCID: PMC9612863 DOI: 10.52054/fvvo.14.1.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Medical 3D imaging is a promising emerging technology that allows recreating the details of human anatomy. The use of this innovative technology has resulted in improved surgical efficiency and better clinical outcomes. However, its incorporation in gynaecologic surgery has not been widely adopted. Objectives To demonstrate the use of Hyper Accuracy 3D reconstruction in a patient with infertility who underwent multiple myomectomy. Materials and Methods A stepwise approach describing the incorporation of Hyper Accuracy 3D imaging technology into the preoperative surgical planning and intraoperative guidance of a patient with multiple myomas undergoing multiple myomectomy. Main outcome measures Preoperative evaluation of a patient with multiple myoma and infertility who presented to our department seeking surgical management. Hyper Accuracy 3D image was obtained, and a 3D digital image reconstruction of the uterus delineating the exact number, volume, and location of the fibroids was created. The 3D digital image was available during the surgical procedure which helped to plan the surgical steps allowing a systematic surgical approach resulting in an effective surgery with minimal blood loss. Results The benefits of intraoperative guidance using Hyper Accuracy 3D in a patient with multiple myomas and infertility are demonstrated. Conclusions The adoption of this promising imaging technology into gynaecologic surgery is feasible and should be further investigated. Additional studies evaluating the clinical impact of using Hyper Accuracy 3D imaging in the preoperative planning of patients with gynaecologic surgical pathology are needed.
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Three-dimensional Model Reconstruction: The Need for Standardization to Drive Tailored Surgery. Eur Urol 2021; 81:129-131. [PMID: 34862098 DOI: 10.1016/j.eururo.2021.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/24/2021] [Accepted: 11/09/2021] [Indexed: 11/20/2022]
Abstract
The clinical utility of three-dimensional virtual models has been widely explored for preoperative planning, patient counseling, surgical training, and intraoperative navigation. There is now a need for standardized methodology for construction of these models so that their utility can be realized in routine practice to achieve the goal of individualized treatment for patients.
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