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MP20-09 ROBOTIC 3D ULTRASOUND-GUIDED TARGETING FOR PERCUTANEOUS RENAL ACCESS

INTRODUCTION AND OBJECTIVES: Percutaneous NephroLithotomy (PCNL) access to the kidney is performed, to date, mostly under X-Ray fluoroscopy. Providing only a 2D image, sometimes includes multiple puncture trials and exposes the patient and staff to ionizing radiation. The same access can be achieved under ultrasound (US) guidance, without radiation exposure and with similar success rate in expert hands. This requires substantial training, skill, and involves a harder learning curve. We developed a simple, easy to operate, US-guided robotic system for acquiring percutaneous renal access. This has the potential to eliminate the trial and error attempts for gaining accurate access, reduce variability among urologists and the required level of skill. METHODS: Our laboratory has developed a robotic ultrasound probe manipulator equipped with a needle guide. Preclinical experiments show accuracy in needle targeting. An US compatible gelatin based mockup with a water filled renal collecting system was made in our lab. Our software uses the robotic controlled US scan in an automated 3DSlicer® volume rendering algorithm to produce an operator friendly 3D reconstruction of the collecting system. The needle trajectory for any selected point in the reconstruct is presented before action is taken (Figure). Three trials on different calyces were performed to examine the control on both target and trajectory of the needle, as needed in PCNL. A first scan of the mockup shows the 3D reconstruct, a desired calyx is chosen, re-positioning of the robot is performed before a second scan and targeting. RESULTS: Two different people easily operated the system and software after a brief preview and one use. Two of the calyces were successfully reached from a desired starting point with the needle using the robotic guidance after the second scan. One calyx required another repositioning and scanning in order to achieve a preferable trajectory before needle insertion. CONCLUSIONS: Using our robotic system may prove to have several clinical advantages; the reconstruct provided with a single scan can help urologists understand the 3D anatomy and orientation of a patient's collecting system, with minimal practice a junior or senior urologist can easily access the collecting system percutaneously using only US imaging. Future clinical trial is needed to test the safety and feasibility of the system. Figure. No caption available. Source of Funding: none