Impact of Surgical Experience on Radiation Exposure during Retrograde Intrarenal Surgery: A Propensity-Score Matching Analysis

Radiation exposure of patients during endourological procedures

PURPOSE

Considering the existing gaps in the literature regarding patient radiation dose (RD) and its associated risks, a systematic review of the literature on RD was conducted, focusing on percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (SWL), and ureteroscopy (URS).

METHODS

Two authors conducted a literature search on PubMed, Web of Science, and Google Scholar to identify studies on RD during endourological procedures. Two thousand two hundred sixty-six articles were screened. Sixty-five publications met the inclusion criteria using the PRISMA standards.

RESULTS

RD was generally highest for PCNL, reaching levels up to 33 mSv, 28,700 mGycm2, and 430.8 mGy. This was followed by SWL, with RD reaching up to 7.32 mSv, 13,082 mGycm2, and 142 mGy. URS demonstrated lower RD, reaching up to 6.07 mSv, 8920 mGycm2, and 46.99 mGy. Surgeon experience and case load were inversely associated with RD. Strategies such as optimizing fluoroscopy settings, implementing ultrasound (US), and following the ALARA (As Low As Reasonably Achievable) principle minimized RD.

CONCLUSIONS

This is the first systematic review analyzing RD, which was generally highest during PCNL, followed by SWL and URS. There is no specific RD limit for these procedures. Implementation of strategies such as optimizing fluoroscopy settings, utilizing US, and adhering to the ALARA principle proved effective in reducing RD. However, further research is needed to explore the factors influencing RD, assess their impact on patient outcomes, and establish procedure-specific reference levels for RD.

Safety enhanced surgical robot for flexible ureteroscopy based on force feedback

BACKGROUND

Although some robotic systems have been developed to improve conventional flexible ureteroscopy (FURS), a widely used intervention in urology, these robots rarely have a comprehensive force feedback function which is important for master-slave controlled surgical robots.

METHODS

Here, we design and fabricate a novel FURS robot with a comprehensive force feedback function. Moreover, to realize better force feedback, a neural network-based method is also demonstrated to estimate the interactive forces between the flexible ureteroscope and the environment.

RESULTS

We show that when teleoperating the flexible ureteroscope with our robot, the operator can accurately feel the obstruction if the interactive axial force or torque exceeds 1.2 N or 15.6 mN·m respectively. For bending movement, augmented force feedback greatly improves the accuracy of the operator's perception of obstruction.

CONCLUSIONS

The developed robotic system with force feedback is expected to improve the safety of robot-assisted FURS.

Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy

PURPOSE

To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS.

METHODS

Data from 235 patients who underwent vamPCNL were analysed. Patient's demographics, stones' characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy's score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT).

RESULTS

iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy's score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS.

CONCLUSION

One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS.

Radiation Exposure of Crystalline Bodies during Interventional Therapy and Related Research Status

The aim of this study was to estimate the exposure dose level of ocular corpuscles during the common interventional procedures of interventional radiology workers. This article retrospectively analyzed the general instruments and equipment of interventional therapy, the general methods and steps of interventional therapy, and the influence of X-ray of interventional surgery. The related contents of eye protection for interventional radiology workers were summarized. This study found that there was a significant linear correlation between the equivalent dose of lens and the exposure time. The tube voltage, tube current, and the size of fluoroscopic field of vision also have an impact on the radiation of workers during surgical exposure. Interventional surgery is difficult and easy. The exposure time of difficult surgery is relatively long, so the dose received by interventional staff is large. The intervention staff should improve their professional knowledge, be proficient in the operation technology, and try to reduce the exposure without affecting the diagnosis and treatment effect. During the intervention operation, the eye substance of the operator is exposed to a certain dose of radiation, and the wearing rate of protective lead glasses of the intervention staff is very low. Therefore, we must pay attention to the protection of the eyes, strengthen the protection management, and reduce the exposure dose of the intervention staff as much as possible.

Varicocele embolization with sclerosing agents leads to lower radiation exposure and procedural costs than coils: Data from a real-life before and after study

Objectives

To investigate clinical outcomes, radiation exposure and procedural costs associated with percutaneous varicocoele embolization using coils and sclerosing agents (SAs) in a cohort of young‐adult men.

Materials and methods

Data from consecutive men treated with percutaneous varicocoele embolization using coils and SA between 2017 and 2021 were analyzed. The allocation was based on a change of policy occurred in June 2020 with the substitution of coils with SA (before and after study). Semen analysis values were based on 2010 WHO reference criteria. Anatomic variants of gonadal veins were categorized according to Jargiello et al. Intraoperative radiation dose and procedural costs were collected for each patient. Descriptive statistics and linear regression models were used to describe the association between clinical parameters with procedural costs and radiation exposure.

Results

One hundred sixteen men were included, of whom 76 (65.5%) received coils, and 40 (34.5%) received SA. Baseline characteristics of the two study groups did not differ. A type 3 Jargiello anatomic variation of left gonadal vein was found in 45.7% of cases. Radiation dose was lower in the SA group as compared to the coils one (13.2 [7–43] vs. 19.8 [12–57] Gy/cm²; p < 0.001). Similarly, procedural costs were lower for the SA group (169.6 [169–199] € vs. 642.5 [561–775] €; p < 0.001). At follow‐up, pain and sperm variables significantly improved in both groups (p < 0.01), without differences among the embolic materials. Linear regression model revealed that coils use was associated with higher radiation exposure (beta 8.8, p = 0.02) than SA after accounting for anatomic variation of gonadal vein, body mass index, and vascular access.

Conclusions

SA and coils for varicocoele embolization are equally safe and effective. The use of SA was associated with lower radiation exposure and procedural costs than coils. These results should be considered in terms of public health cost and patient's safety.