An automated system for precise percutaneous access of the renal collecting system

Bzostek, Andrew; Schreiner, Steven; Barnes, A.; Cadeddu, Jeffrey A.; Roberts, William W.; Anderson, James H.; Taylor, Russell H.; Kavoussi, Louis R.

doi:10.1007/bfb0029249

Cited by 32 publications

(20 citation statements)

References 4 publications

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“…This experimental system is able to access a specific renal calyx percutaneously with the assistance of single two-dimensional fluoroscopic images. Bzostek et al [8] report that PAKY successfully accessed the targeted calyx on the first attempt 83% of the time.…”

Section: Urologic Robotsmentioning

confidence: 98%

Principles and advantages of robotics in urologic surgery

Renda

Vallancien

2003

Curr Urol Rep

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Although the available minimally invasive surgical techniques (ie, laparoscopy) have clear advantages, these procedures continue to cause problems for patients. Surgical tools are limited by set axes of movement, restricting the degree of freedom available to the surgeon. In addition, depth perception is lost with the use of two-dimensional viewing systems. As surgeons view a "virtual" target on a television screen, they are hampered by decreased sensory input and a concurrent loss of dexterity. The development of robotic assistance systems in recent years could be the key to overcoming these difficulties. Using robotic systems, surgeons can experience a more natural and ergonomic surgical "feel." Surgical assistance, dexterity and precision enhancement, systems networking, and image-guided therapy are among the benefits offered by surgical robots. In return, the surgeon gains a shorter learning curve, reduced fatigue, and the opportunity to perform complex procedures that would be difficult using conventional laparoscopy. With the development of image-guided technology, robotic systems will become useful tools for surgical training and simulation. Remote surgery is not a routine procedure, but several teams are working on this and experiencing good results. However, economic concerns are the major drawbacks of these systems; before remote surgery becomes routinely feasible, the clinical benefits must be balanced with high investment and running costs.

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Section: Urologic Robotsmentioning

confidence: 98%

Principles and advantages of robotics in urologic surgery

Renda

Vallancien

2003

Curr Urol Rep

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“…The robotic device will be based on the RCM-PAKY (Remote Center of Motion/Percutaneous Access of the Kidney) Robot, which has been developed at Johns Hopkins and applied to percutaneous access of the renal collecting system [47]- [49]. The robot, schematically represented in Fig.…”

Section: E Mechanical Guidancementioning

confidence: 99%

Technology improvements for image-guided and minimally invasive spine procedures

Cleary

Clifford

Stoianovici³

et al. 2002

IEEE Trans. Inform. Technol. Biomed.

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Abstract-This paper reports on technology developments aimed at improving the state of the art for image-guided minimally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal surgery. Image guidance is an enabling technology for minimally invasive procedures, but technical problems remain that may limit the wider applicability of these techniques. The paper begins with a discussion of low back pain and the potential shortcomings of open back surgery. The advantages of minimally invasive procedures are enumerated, followed by a list of technical problems that must be overcome to enable the more widespread dissemination of these techniques. The technical problems include improved intraoperative imaging, fusion of images from multiple modalities, the visualization of oblique paths, percutaneous spine tracking, mechanical instrument guidance, and software architectures for technology integration. Technical developments to address some of these problems are discussed next. The discussion includes intraoperative computerized tomography (CT) imaging, magnetic resonance imaging (MRI)/CT image registration, three-dimensional (3-D) visualization, optical localization, and robotics for percutaneous instrument placement. Finally, the paper concludes by presenting several representative clinical applications: biopsy, vertebroplasty, nerve and facet blocks, and shunt placement. The program presented here is a first step to developing the physician-assist systems of the future, which will incorporate visualization, tracking, and robotics to enable the precision placement and manipulation of instruments with minimal trauma to the patient. Index Terms-Interoperative imaging, magnetic resonance imaging (MRI)/computerized tomography (CT) registration, medical robotics, minimally invasive procedures, spine, threedimensional (3-D) visualization.

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“…Pioneering work by two groups has led to the development of robots that could assist with and simplify intraoperative percutaneous renal access. [6][7][8] Clinical applications of these devices, however, have not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Robotic Percutaneous Access to the Kidney: Comparison with Standard Manual Access

Stoianovici

Jarrett

et al. 2002

Journal of Endourology

131

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Purpose: To evaluate the efficiency, accuracy, and safety of robotic percutaneous access to the kidney (PAKY) for percutaneous nephrolithotomy in comparison with conventional manual techniques. Materials and Methods:We compared the intraoperative access variables (number of access attempts, time to successful access, estimated blood loss, complications) of 23 patients who underwent robotic PAKY with the remote center of motion device (PAKY-RCM) with the same data from a contemporaneous series of 23 patients who underwent conventional manual percutaneous access to the kidney. The PAKY-RCM incorporates a robotic arm and a friction transmission with axial loading system to accurately position and insert a standard 18-gauge needle percutaneously into the kidney. The blood loss during percutaneous access was estimated on a four-point scale (1 5 minimal to 4 5 large). The color of effluent urine was graded on a fourpoint scale (1 5 clear to 4 5 red).Results: The mean target calix width was 13.5 6 9.2 mm in the robotic group and 12.2 6 4.5 mm in the manual group (P 5 0.57). When comparing PAKY-RCM with standard manual techniques, the mean number of attempts was 2.2 6 1.6 v 3.2 6 2.5 (P 5 0.14), time to access was 10.4 6 6.5 minutes v 15.1 6 8.8 minutes (P 5 0.06), estimated blood loss score was 1.3 6 0.49 v 1.7 6 0.66 (P 5 0.14), and color of effluent urine following access was 2.0 6 0.90 v 2.1 6 0.7 (P 5 0.82). The PAKY-RCM was successful in obtaining access in 87% (20 of 23) of cases. The other three patients (13%) required conversion to manual techniques. There were no major intraoperative complications in either group.Conclusions: Robotic PAKY is a feasible, safe, and efficacious method of obtaining renal access for nephrolithotomy. The number of attempts and time to access were comparable to those of standard manual percutaneous access techniques. These findings provide the groundwork for the development of a completely automated robot-assisted percutaneous renal access device.

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An automated system for precise percutaneous access of the renal collecting system

Cited by 32 publications

References 4 publications

Principles and advantages of robotics in urologic surgery

Principles and advantages of robotics in urologic surgery

Technology improvements for image-guided and minimally invasive spine procedures

Robotic Percutaneous Access to the Kidney: Comparison with Standard Manual Access

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