EURURO Vol. 72 No. 4

610 656

Surgery in Motion
Ureteroscopy-assisted Percutaneous Kidney Access Made Easy:
First Clinical Experience with a Novel Navigation System Using
Electromagnetic Guidance (IDEAL Stage 1)
Estevao Lima Pedro L. Rodrigues Paulo Mota Nuno Carvalho Emanuel Dias
Jorge Correia-Pinto Riccardo Autorino Joa˜o L. Vilac¸ a
a Department of CUF Urology, Surgical Sciences Research Domain, Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga,
Portugal; b DIGARC, Polytechnic Institute of Ca´vado and Ave, Barcelos, Portugal
available at
journal homepage:
Article info
Article history:
Accepted March 7, 2017
Associate Editor:
Alexandre Mottrie
Keywords:
Combined access
Kidney puncture
Surgical navigation
Kidney access
Percutaneous nephrolithotomy
Image-guided surgery
Real time
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Abstract
Background: Puncture of the renal collecting system represents a challenging step in
percutaneous nephrolithotomy (PCNL). Limitations related to the use of standard
fluoroscopic-based and ultrasound-based maneuvers have been recognized.
Objectives: To describe the technique and early clinical outcomes of a novel navigation
system for percutaneous kidney access.
Design, setting, and participants: This was a proof-of-concept study (IDEAL phase 1)
conducted at a single academic center. Ten PCNL procedures were performed for
patients with kidney stones.
Surgical procedure: Flexible ureterorenoscopy was performed to determine the optimal
renal calyx for access. An electromagnetic sensor was inserted through the working
channel. Then the selected calyx was punctured with a needle with a sensor on the tip
guided by real-time three-dimensional images observed on the monitor.
Outcome measurements and statistical analysis: The primary endpoints were the
accuracy and clinical applicability of the system in clinical use. Secondary endpoints
were the time to successful puncture, the number of attempts for successful puncture,
and complications.
Results and limitations: Ten patients were enrolled in the study. The median age was
47.1 yr (30–63), median body mass index was 22.85 kg/m2 (19–28.3), and median stone
size was 2.13 cm (1.5–2.5 cm). All stones were in the renal pelvis. The Guy’s stone score
was 1 in nine cases and 2 in one case. All 10 punctures of the collecting system were
successfully completed at the first attempt without X-ray exposure. The median time to
successful puncture starting from insertion of the needle was 20 s (range 15–35). No
complications occurred.
Conclusions: We describe the first clinical application of a novel navigation system
using real-time electromagnetic sensors for percutaneous kidney access. This new
technology overcomes the intrinsic limitations of traditional methods of kidney access,
allowing safe, precise, fast, and effective puncture of the renal collecting system.
Patient summary: We describe a new technology allowing safe and easy puncture of the
kidney without radiation exposure. This could significantly facilitate one of the most
challenging steps in percutaneous removal of kidney stones.
# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. Department of CUF Urology, Surgical Sciences Research Domain, Life and
Health Sciences Research Institute, School of Medicine, University of Minho, 4709-057 Braga,
Portugal. Tel. +351 919327639; Fax: +351 253 604809.
E-mail address: (E. Lima).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.