Presented by: Sikai Song MD
Loma Linda University Health

Introduction

Fluoroscopic-guided renal access exposes patients and staff to substantial radiation. The Laser Direct Alignment Radiation Reduction Technique (DARRT) is a hybrid technique utilizing fluoroscopy, ultrasound, endoscopic vision, and laser targeting to reduce fluoroscopy use and improve outcomes. The purpose of this study was to compare Laser DARRT to conventional fluoroscopic-guided PCNL.  

Materials

A retrospective review was performed of all patients undergoing PCNL at a single academic institution from January 2017 to March 2023. Patients with pre-existing nephrostomy tubes used for access and only ultrasound-guided access were excluded. Renal access was categorized into either fluoroscopy or Laser DARRT. The primary outcomes of interest were total fluoroscopy time and fluoroscopy time used for renal access. Secondary outcomes were stone-free rates (SFR), complication rates, procedure time, length of stay, and need for additional procedures. The independent samples t-test was used to compare continuous variables and the Chi-squared test was used to compare categorical variables between groups, with p<0.05 significant.  

Results

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A total of 292 patients met inclusion criteria. Baseline patient characteristics were similar between groups (Table 1). There was no significant difference in stone laterality, stone volume, and Hounsfield units, however there was a higher percentage of staghorn calculi in the Laser DARRT group (84.6% vs 67%; p=0.001). The Laser DARRT technique resulted in significantly lower total fluoroscopy time (21.8 vs 597.7 sec; p<0.001) and fluoroscopy time for access (10.8 vs 551.7 sec; p<0.001). There was no significant difference in total procedure times, length of stay, blood loss, or complication rates between groups (Table 1). SFR was significantly higher for the Laser DARRT group (84.1% vs 64.1%; p<0.001).  

Conclusion

Laser DARRT reduced mean renal access fluoroscopy time by 98% and total fluoroscopy time by 96.4% during PCNL. Despite reduced fluoroscopy time, laser DARRT had higher stone-free rates and similar operative times, estimated blood loss, and complication rates.   

Funding

None

Lead Authors

Alphie Rotinsulu,
Loma Linda University Health

Co-Authors

Ala'a Farkouh, MD
Loma Linda University Health

Matthew Buell, MD
Loma Linda University Health

Akin S. Amasyali, MD
Loma Linda University Health

Rose Leu, MD
Loma Linda University Health

Kanha Shete, DO
Loma Linda University Health

Carter Ware,
Loma Linda University Health

Vance Gentry,
Loma Linda University Health

Sikai Song, MD
Loma Linda University Health

Grant Sajdak,
Loma Linda University Health

Cliff DeGuzman,
Loma Linda University Health

D. Duane Baldwin, MD
Loma Linda University Health