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Image-guided surgical planning of percutaneous nephrolithotomy with patient-specific CTRs

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

We propose the utilization of patient-specific concentric-tube robots (CTRs) whose designs are optimized to enhance their volumetric reachability of the renal stone, thus reducing the morbidities associated with percutaneous nephrolithotomy procedures. By employing a nested optimization-driven scheme, this work aims to determine a single surgical tract through which the patient-tailored CTR is deployed. We carry out a sensitivity analysis on the combined percutaneous access and optimized CTR design with respect to breathing-induced excursion of the kidneys based on preoperative images. Further, an investigation is also performed of the appropriateness and effectiveness of the percutaneous access provided by the proposed algorithm compared to that of an expert urologist.

Methods

The method is based on an ellipsoidal approximation to the renal calculi and a grid search over candidate skin areas and available renal calyces using an anatomically constrained kinematic mapping of the CTR. Percutaneous access is selected for collision-free CTR deployment to the centroid of the stones with minimal positional error at the renal calyx. Further optimization of the CTR design results in a robot tailored to the therapeutic anatomical features of each clinical case. The study examined 14 sets of clinical data of PCNL patients, analyzing stone reachability using preoperative images and breathing-induced motions of the kidney. An experienced urologist qualitatively assessed the adequacy of percutaneous access generated by the algorithm.

Results

An assessment conducted by an expert urologist found that the percutaneous accesses produced by the proposed approach were found to be comparable to those chosen by the expert surgeon in most clinical cases. The simulated results demonstrated a mean volume coverage of \(81.6\%\pm 19.6\%\) for static anatomy and \(63.7\%\pm 27.7\%\) and \(69.0\%\pm 25.4\%\) when considering a 1 cm excursion of the kidney in the craniocaudal directions due to respiration or tool-tissue interaction.

Conclusion

The optimization-driven scheme for determining a single tract surgical plan, coupled with the use of a patient-specific CTR, shows promising results for improving percutaneous access in PCNL procedures. This approach clearly shows the potential for enhancing the quality and suitability of percutaneous accesses, addressing the challenges posed by staghorn and non-staghorn stones during PCNL procedures. Further research involving clinical validation is necessary to confirm these findings and explore the potential clinical benefits of the approach.

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Notes

  1. We refer the interested reader to our previous work [16, p. 630] for details on the computation of the minimum volume coverage ellipsoid for the kidney stones.

  2. It should be noted that this design choice resulting in a 5 DoF CTR represents a particular case within the wider array of possible CTR designs. The general framework presented in this paper is not limited by this design choice and, thus holds potential for a myriad of medical applications extending beyond the purview of PCNL.

  3. The notation \(E_{Q,c}\) is used to denote that the MVCE has centroid at \(c\in {\mathbb {R}}^3\) and its semi-axes have lengths \(\sqrt{\lambda _i}\) in the direction \(v(\lambda _i)\) where \(\lambda _i\) and \(v(\lambda _i)\) are respectively the real eigenvalues and eigenvectors of the symmetric matrix Q.

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Acknowledgements

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health through Grant Number R01DK119269 and by the Natural Sciences and Engineering Research Council (NSERC) of Canada Grant RGPIN1345, and the Canada Research Chairs Program.

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Authors and Affiliations

  1. Western University, London, Canada

    Filipe C. Pedrosa, Navid Feizi & Rajni V. Patel

  2. Canadian Surgical Technologies and Advanced Robotics, London, Canada

    Filipe C. Pedrosa, Navid Feizi & Rajni V. Patel

  3. Brigham and Women’s Hospital, Boston, USA

    Ruisi Zhang, Remi Delaunay & Jayender Jagadeesan

  4. Harvard Medical School, Boston, USA

    Ruisi Zhang, Remi Delaunay, Dianne Sacco & Jayender Jagadeesan

  5. Massachusetts General Hospital, Boston, USA

    Dianne Sacco

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  1. Filipe C. Pedrosa
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  2. Navid Feizi
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  4. Remi Delaunay
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Correspondence to Filipe C. Pedrosa.

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Pedrosa, F.C., Feizi, N., Zhang, R. et al. Image-guided surgical planning of percutaneous nephrolithotomy with patient-specific CTRs. Int J CARS 19, 801–810 (2024). https://doi.org/10.1007/s11548-023-03029-3

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