Advances in percutaneous renal puncture: a comprehensive review of the literature

Abstract

Purpose of reviewPercutaneous nephrolithotomy (PCNL) constitutes the gold standard procedure for patients suffering from more than 2 cm renal stones. The puncture is a very critical step of PCNL, affecting manoeuvrability of the nephroscope, possibility to remove stone fragments, risk of bleeding and radiation exposure. The aim of the current review was to discuss the advances in percutaneous renal puncture. Recent findingsFollowing technological evolution in medicine, there was a consistent development in the puncture techniques, aiming at the improvement of its efficacy and safety. The use of specific agents can improve ultrasonic guidance, making the challenging step of gaining access to the kidney easier for the experienced surgeon and more accessible for the resident urologist. Future developments in the electromagnetic and three-dimensional (3D) technology may establish a high level of accuracy with decreased rates of related complications, even in the hands of beginners.

Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery

“…Endoscopes are the main imaging and guidance tools for minimally invasive surgical instruments with multiple functions and application scenarios. 25 The existing endoscopes can be divided into laparoscopes for intra-abdominal applications, 47,48 cystoscopes for intrabladder applications, 49,50 nephroscopes for kidney applications, 51,52 and bronchoscopes for tracheal applications, 53,54 etc., depending on the target organ site. In addition, endoscopes also include arthroscopy, gastroscopy, neuroscope, stomatoscope, and other categories.…”

“…Endoscopes are the main imaging and guidance tools for minimally invasive surgical instruments with multiple functions and application scenarios . The existing endoscopes can be divided into laparoscopes for intra-abdominal applications, , cystoscopes for intrabladder applications, , nephroscopes for kidney applications, , and bronchoscopes for tracheal applications, , etc., depending on the target organ site. In addition, endoscopes also include arthroscopy, gastroscopy, neuroscope, stomatoscope, and other categories. − Endoscopes are slender tube-like instruments fabricated from image acquisition devices such as fiber optic bundles, LED arrays, or high-frequency fluorescent lamps, which can be inserted into biological cavities (e.g., bladder, intestine) for optical information transmission, acquiring image information on the surface of organs to assist physicians in diagnosing lesions based on tissue morphology.…”

Three-Dimensional Printing Creates New Trends of the Technological Revolution in Urologic Surgery

“…3D printing technology allows surgeons to comprehensively understand the details of kidney anatomy and calculus before surgery, which helps to select the best puncture channel before surgery and reduce the probability of surgical complications. 63 Xu et al 64 included 12 patients with staghorn calculus larger than 4 cm in their study and used 3D printing technology to make three models for each patient. Three puncture points were selected from the upper, middle, and lower renal vessels to record the stone clearance rate of each simulated puncture, and the puncture site with the highest stone clearance rate was applied in the actual operation.…”

Navigation systems and 3D imaging in percutaneous nephrolithotripsy: improving outcomes and safety

“…Nevertheless, despite its remarkable evolution during the last decades [3,4], morbidity remains considerable [5,6]. One of the most critical steps is a precise puncture, among others [7,8], affecting scope maneuverability, the possibility of removing fragments, bleeding risk, and radiation exposure [9]. Lack of adequate preoperative planning or a surgeon's inexperience may result in serious complications [6].…”