Aid to Percutaneous Renal Access by Virtual Projection of the Ultrasound Puncture Tract onto Fluoroscopic Images

TL;DR

This paper introduces a computerized system that enhances percutaneous renal access by real-time projection of ultrasound-guided puncture paths onto fluoroscopic images, aiming to improve precision and safety in PCNL procedures.

Contribution

The paper presents a novel system that superimposes ultrasound puncture tracts onto fluoroscopic images in real time without image processing, validated through laboratory and initial clinical testing.

Findings

System is reliable in phantom experiments

Successfully validated in a clinical setting during PCNL

Robust due to lack of complex image processing

Abstract

Background and Purpose: Percutaneous renal access in the context of percutaneous nephrolithotomy (PCNL) is a difficult technique, requiring rapid and precise access to a particular calix. We present a computerized system designed to improve percutaneous renal access by projecting the ultrasound puncture tract onto fluoroscopic images. Materials and Methods: The system consists of a computer and a localizer allowing spatial localization of the position of the various instruments. Without any human intervention, the ultrasound nephrostomy tract is superimposed in real time onto fluoroscopic images acquired in various views. Results: We tested our approach by laboratory experiments on a phantom. Also, after approval by our institution's Ethics Committee, we validated this technique in the operating room during PCNL in one patient. Conclusion: Our system is reliable, and the absence of image-processing procedures makes it robust. We have initiated a prospective study to validate this technique both for PCNL specialists and as a learning tool.