iPad-assisted percutaneous nephrolithotomy (PCNL): a matched pair analysis compared to standard PCNL.

Area of Science:

• Urology
• Medical Technology
• Surgical Navigation

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
• Current techniques rely on ultrasound and fluoroscopy for guidance.
• Advancements in technology aim to improve precision and reduce complications.

Purpose of the Study:

• To compare the efficacy and safety of iPad-assisted percutaneous access to the kidney versus the standard puncturing technique for PCNL.
• To evaluate puncture time, radiation exposure, and the number of attempts for successful puncture.

Main Methods:

• A prospective study comparing 22 patients undergoing iPad-assisted PCNL with 22 matched controls receiving standard PCNL.
• iPad-assisted PCNL utilized pre-operative CT scans with segmented anatomical structures superimposed on an iPad via marker-based navigation.
• Standard PCNL used ultrasound and fluoroscopy guidance. Statistical analysis included Chi-square, t-test, U test, and Kruskal-Wallis tests.

Main Results:

• The standard puncturing method demonstrated significantly lower radiation exposure (p<0.01) and shorter puncture times (p=0.01) compared to the iPad-assisted method.
• No significant difference was observed in the number of puncture attempts between the two groups (p=0.45).

Conclusions:

• iPad-assisted navigation for renal collecting system puncture is a novel technique (IDEAL criteria 2b) feasible in clinical practice.
• While applicable, the iPad-assisted technique requires further technical refinement to optimize outcomes compared to the standard method.