Advertisement

Navigated renal access using electromagnetic tracking: an initial experience

Abstract

Background and aim

Navigation systems are promising tools for improving efficacy and safety in surgical endoscopy and other minimally invasive techniques. The aim of the current study is to investigate electromagnetic tracking (EMT) for navigated renal access in a porcine model.

Methods

For our proof-of-principle study we modified a recently established porcine ex vivo model. Via a ureteral catheter which was placed into the desired puncture site, a small sensor was introduced and located by EMT. Then, a tracked needle was navigated into the collecting system in a “rendezvous” approach. A total of 90 renal tracts were obtained in six kidneys using EMT, with a maximum of three punctures allowed per intervention. For each puncture, number of attempts to success, final distance to probe, puncture time, and localization were assessed. We compared absolute and relative frequencies using the chi-square test and applied the Mann–Whitney U-test for continuous variables.

Results

No major problems were encountered performing the experiment. Access to the collecting system was successfully obtained after a single puncture in 91% (82/90) and within a second attempt in the remaining 9% (8/90). Thus, a 100% success rate was reached after a maximum of two punctures. Location of the calyx did not have a significant effect on success rate (p = 0.637). After a learning phase of 30 punctures, higher success rate (96% versus 83%; p = 0.041) was accomplished within shorter puncture time (14 versus 17 s; p = 0.049) and with higher precision (1.7 versus 2.8 mm; p < 0.001).

Conclusions

With respect to other established techniques, use of EMT seems to decrease the number of attempts and procedural time remarkably. This might contribute to greater safety and efficacy when applied clinically. The presented approach appears to be promising, especially in difficult settings, provided that in vivo data support these initial results.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Steinberg PL, Semins MJ, Wason SEL, Matlaga BR, Pais VM (2009) Fluoroscopy-guided percutaneous renal access. J Endourol 23:1627–1631

  2. 2.

    Desai M (2009) Ultrasonography-guided punctures – with and without puncture guide. J Endourol 23:1641–1643

  3. 3.

    Watterson JD, Soon S, Jana K (2006) Access related complications during percutaneous nephrolithotomy: urology versus radiology at a single academic institution. J Urol 176:142–145

  4. 4.

    Lewis S, Patel U (2004) Major complications after percutaneous nephrostomy – lessons from a department audit. Clin Radiol 59:171–179

  5. 5.

    Chalmers N, Jones K, Drinkwater K, Uberoi R, Tawn J (2008) The UK nephrostomy audit. Can a voluntary registry produce robust performance data? Clin Radiol 63:888–894

  6. 6.

    Ko R, Razvi H (2007) C-arm laser positioning device to facilitate percutaneous renal access. Urology 70:360–361

  7. 7.

    Mozer P, Conort P, Leroy A, Baumann M, Payan Y, Troccaz J, Chartier-Kastler E, Richard F (2007) Aid to percutaneous renal access by virtual projection of the ultrasound puncture tract onto fluoroscopic images. J Endourol 21:460–465

  8. 8.

    Challacombe B, Patriciu A, Glass J, Aron M, Jarrett T, Kim F, Pinto P, Stoianovici D, Smeeton N, Tiptaft R, Kavoussi L, Dasgupta P (2005) A randomized controlled trial of human versus robotic and telerobotic access to the kidney as the first step in percutaneous nephrolithotomy. Comput Aided Surg 10:165–171

  9. 9.

    Hosking DH (1986) Retrograde nephrostomy: experience with 2 techniques. J Urol 135:1146–1149

  10. 10.

    Zhang Y, Ou T-W, Jia J-G, Gao W, Cui X, Wu J-T, Wang G (2008) Novel biologic model for percutaneous renal surgery learning and training in the laboratory. Urology 72:513–516

  11. 11.

    Glossop ND (2009) Advantages of optical compared with electromagnetic tracking. J Bone Joint Surg 91:23–28

  12. 12.

    Hildebrand P, Schlichting S, Martens V, Besirevic A, Kleemann M, Roblick U, Mirow L, Bürk C, Schweikard A, Bruch H-P (2008) Prototype of an intraoperative navigation and documentation system for laparoscopic radiofrequency ablation: first experiences. Eur J Surg Oncol 34:418–421

  13. 13.

    Meyer BC, Peter O, Nagel M, Hoheisel M, Frericks BB, Wolf K-J, Wacker FK (2008) Electromagnetic field-based navigation for percutaneous punctures on C-arm CT: experimental evaluation and clinical application. Eur Radiol 18:2855–2864

  14. 14.

    Willoughby TR, Kupelian PA, Pouliot J, Shinohara K, Aubin M, Roach M, Skrumeda LL, Balter JM, Litzenberg DW, Hadley SW, Wei JT, Sandler HM (2006) Target localization and real-time tracking using the Calypso 4D localization system in patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 65:528–534

  15. 15.

    Lashley DB, Fuchs EF (1998) Urologist-acquired renal access for percutaneous renal surgery. Urology 51:927–931

  16. 16.

    Su L-M, Stoianovici D, Jarrett TW, Patriciu A, Roberts WW, Cadeddu JA, Ramakumar S, Solomon SB, Kavoussi LR (2002) Robotic percutaneous access to the kidney: comparison with standard manual access. J Endourol 16:471–475

  17. 17.

    Egilmez H, Oztoprak I, Atalar M, Cetin A, Gumus C, Gultekin Y, Bulut S, Arslan M, Solak O (2007) The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience. Acta Radiol 48:806–813

  18. 18.

    Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54:1393–1403

  19. 19.

    Santos RS, Gupta A, Ebright MI, DeSimone M, Steiner G, Estrada M-J, Daly B, Fernando HC (2010) Electromagnetic navigation to aid radiofrequency ablation and biopsy of lung tumors. Ann Thorac Surg 89:265–268

Download references

Disclosures

Authors Johannes Huber, Ingmar Wegner, Hans-Peter Meinzer, Peter Hallscheidt, Boris Hadaschik, Sascha Pahernik, and Markus Hohenfellner have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Johannes Huber.

Additional information

Johannes Huber and Ingmar Wegner contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MPG 10217 kb)

Supplementary material 1 (MPG 10217 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Huber, J., Wegner, I., Meinzer, H. et al. Navigated renal access using electromagnetic tracking: an initial experience. Surg Endosc 25, 1307–1312 (2011). https://doi.org/10.1007/s00464-010-1338-x

Download citation

Keywords

  • Electromagnetic tracking
  • Navigation
  • Percutaneous renal access
  • Endourology