Presented by: Kazumi Taguchi MD,PhD
Nagoya City University

Introduction

We previously reported the efficacy of robot-assisted fluoroscopy-guided (RAG) puncture in percutaneous nephrolithotomy (PCNL). In the current study, we compared ultrasound-guided (USG) puncture with RAG puncture by 1) determining the learning curve for surgical outcome from a pooled clinical trial data, then 2) by using the improved version of robot system for percutaneous renal puncture (ANT-X^@), which enabled us to perform horizontal puncture in the supine position (Figure1).

Materials

1) The surgical outcomes of RAG PCNL were analyzed to calculate the learning curve and then compared with the 300 USG PCNL database. 2) We conducted a multicenter prospective benchtop study with a renal phantom model using the improved version of ANT-X^®︎. The participants were 17 urologists who punctured the renal phantom model using RAG and USG techniques. The single puncture success rates, time from device setup to puncture, puncture time, and fluoroscopic usage time were recorded, and the surgeon’s self-assessment using the NASA-Task Load Index was conducted for the analyses.

Results

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1) In the RAG group, the learning curve for percutaneous access duration and surgical time was steeper than that in the USG group. The stone-free rate and complications significantly improved as cases accumulated per resident in the USG group, whereas there was no statistical difference in these outcomes by case accumulation in the RAF group. 2) A total of 32 urologists participated in this study. The single-puncture success rates of the RAG and USG techniques were 91% and 56%, respectively (p < 0.01). In the RAG technique, the median device setup time was longer (146 and 25 s, p < 0.01), whereas the median needle puncture time (18 and 34 s, p < 0.01) and the deviation from the target center (16 and 26 mm, p<0.01) were shorter than those in the USG technique, respectively. The results of the surgeon’s self-assessment showed that the Mean Weighted Workload Score was lower in the RAG technique than in the USG technique (25 and 60, p < 0.01); the mental workload was significantly smaller in the RAG technique.

Conclusion

The RAG technique showed higher accuracy rates of puncture and smaller mental workload than the USG technique for renal puncture.

Funding

None

Co-Authors

Teruaki Sugino, MD,PHD
Nagoya City University

Ryusuke Deguchi, MD
Wakayama Medical University

Takahiro Yanase, MD
Nagoya City University

Kengo Kawase, MD
Nagoya City University

Shimpei Yamashita, MD,PHD
Wakayama Medical University

Rei Unno, MD,PHD
Nagoya City University

Shuzo Hamamoto, MD,PHD
Nagoya City University

Atsushi Okada, MD,PHD
Nagoya City University

Takahiro Yasui, MD,PHD
Nagoya City University