Automated Needle Targeting with X-ray (ANT-X) - Robot-assisted device for percutaneous nephrolithotomy (PCNL) with its first successful use in human.

Oo, Mon Mon; Gandhi, Himesh Ramesh; Chong, Kian Tai; Goh, Jin Quan; Ng, Ka Wei; Hein, Aung Thaw; Tan, York Kiat

doi:10.1089/end.2018.0003

Cited by 31 publications

(20 citation statements)

References 6 publications

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“…Fed with the data from fluoroscopy, it aligns the needle to the correct direction and depth in the bull's eye technique. The needle is advanced manually [28].…”

Section: Fluoroscopymentioning

confidence: 99%

Percutaneous nephrolithotomy – the puncture

Alken

2021

BJU International

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ObjectiveTo determine what importance is given to the puncture and assistive technologies in percutaneous nephrolithotomy (PNL) in the current urological literature. MethodsPubMed was searched for English publications and reviews for the keywords: 'percutaneous nephrolithotomy', 'percutaneous nephrostomy', 'puncture'. The search was limited to the last 5 years, January 2016 until February 2021. Based on 183 abstracts, 121 publications were selected, read, and reviewed. References, older or seminal papers were read and cited if they contributed to a better understanding. A total of 198 references form the basis of this narrative review. ResultsThe puncture is frequently referred to as the most crucial part of PNL. In contrast, the influence of the puncture on the failure rate of PNL and the specific puncture-related complications seems to be low in the single-digit percentage range. However, there are no universally accepted definitions and standards measuring the quality of puncture. Consequently, the impact of the puncture on general PNL complications, on stone scores predicting success rates and on learning curves evaluating surgeons' performance have not been systematically studied. Assistive technologies rely on fluoroscopy and ultrasonography, the latter of which is becoming the preferred imaging modality for monitoring the entire procedure. Needle bending, a problem relevant to all puncture techniques, is not addressed in the urological literature. ConclusionsThe importance attached to puncture in PNL in the current urological literature is subjectively high but objectively low. Some basics of puncture are not well understood in urology. Disciplines other than urology are more actively involved in the development of puncture techniques.

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“…Fed with the data from fluoroscopy, it aligns the needle to the correct direction and depth in the bull's eye technique. The needle is advanced manually [28].…”

Section: Fluoroscopymentioning

confidence: 99%

Percutaneous nephrolithotomy – the puncture

Alken

2021

BJU International

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“…For RAG puncture, we utilized the ANT-X, 14 which integrated both an articulated reusable arm mounted on the operating table and a computer system connected to a standard C-arm for automated needle positioning to access the target balls mimicking renal stones (Fig. 3C, D).…”

Section: Participants and Proceduresmentioning

confidence: 99%

“…The ANT-X system is used for prone fluoroscopy-guided PCNL with bull's eye technique, 15 and its principles were described previously. 14 The software activation and robotic arm attachment to the operation table were completed beforehand. After the initial marking ( Fig.…”

Section: Participants and Proceduresmentioning

confidence: 99%

“…13 The automated needle targeting with X-ray (ANT-X) robotassisted device is the latest automated robot with AI for fluoroscopy-guided PCNL access. 14 The computer vision software performs fluoroscopic imaging analysis captured by the system to auto calibrate the navigation, with the algorithm calculating the required distance and direction and tilt angle compensation from skin to renal collecting system aimed. A previous article with a pig model demonstrated that this device reduced radiation exposure and complication after the procedure, which allowed us to compare the clinical efficacy between this new technology and the current renal access methods, such as USG.…”

Section: Introductionmentioning

confidence: 99%

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Robot-Assisted Fluoroscopy Versus Ultrasound-Guided Renal Access for Nephrolithotomy: A Phantom Model Benchtop Study

Taguchi

Hamamoto

Okada

et al. 2019

Journal of Endourology

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Objectives: To evaluate the feasibility of robot-assisted fluoroscopy-guided (RAG) puncture and to compare RAG puncture, utilizing a novel robot system for percutaneous renal access, with ultrasound-guided (USG) puncture. Materials and Methods: We conducted a benchtop study with a renal phantom model using the automated needle targeting with an X-ray system. Seventeen urologists participated in this study and performed RAG and USG phantom punctures. The number of needle punctures, device setup time, and fluoroscopic exposure duration were recorded for the analyses. Results: The single puncture success rates of the RAG and USG punctures were 100% and 70.6%, respectively (p = 0.021). The median needle puncture time of RAG puncture was 24% shorter than that of USG puncture (35.0 vs 46.0 seconds; p < 0.001), and the median device setup time of RAG puncture was a minute longer than that of USG puncture (93.0 vs 30.5 seconds; p < 0.001). The median duration of fluoroscopic exposure of RAG puncture was longer than that of USG puncture (38.0 vs 6.5 seconds; p < 0.001). The surgeon's self-assessment results demonstrated that the participating urologists found RAG puncture to be safer and have better visibility than USG puncture; they were also more satisfied with RAG puncture. Subanalysis revealed that, in the RAG group, the attending surgeons had shorter total procedural time than the residents (p = 0.045). Conclusion: RAG puncture showed comparable results and accuracy rates with USG puncture for renal access.

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“…1). 5 In this report, we describe our initial experience with the ANT device and the associated safety and e cacy during the establishment of the initial puncture and renal access for PCNL.…”

Section: Introductionmentioning

confidence: 99%

Automated Needle Targeting (ANT) Device-Assisted Renal Access during Percutaneous Nephrolithotripsy (PCNL) Puncture: A Pilot Study to Assess the Safety and Efficacy of a Novel Technique

Chai

Yeoh

Fadzli

et al. 2020

Preprint

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Abstract Background: To explore the use of an automated needle targeting (ANT) device as an assistive intraoperative navigation modality during PCNL for the treatment of large renal stones, with the aim of reducing surgical durations and radiation exposure.Methods: This open-label, single-surgeon clinical trial included patients with a diagnosis of renal stones for whom PCNL using the ANT device via the percutaneous access technique was indicated. Ethical approval was obtained from the UMMC ethics review board (Ref. 20118105-6740). The ANT was assembled after an initial motor calibration, and the image calibration was performed using the patient’s fluoroscopic images. Subsequently, the ANT software calculated a bullseye alignment before percutaneous puncture. Accurate renal access was confirmed by the efflux of urine in the Chiba biopsy needle, as well as by imaging with the C-arm intensifier at different angles. The primary endpoints were the time to successful renal access (from ANT set-up to urine efflux) and adverse events.Results: In all cases, successful renal access was achieved with a single attempt. The mean time to renal access was 6 minutes, 8 seconds. The mean fluoroscopy duration was 101 seconds, with a mean radiation dose of 23.46 mGy. No adverse events were documented.Conclusion: The ANT device enabled successful, safe and efficient renal access for PCNL in this study. Further research is needed to justify the effectiveness of this device in terms of enabling accurate renal access while reducing the surgical duration and radiation exposure to both surgeons and patients.

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Automated Needle Targeting with X-ray (ANT-X) - Robot-assisted device for percutaneous nephrolithotomy (PCNL) with its first successful use in human.

Abstract: ANT-X system can potentially help surgeons feel confident and potentially reduce complications, hence enabling more surgeons to adopt this procedure.

Cited by 31 publications

References 6 publications

Percutaneous nephrolithotomy – the puncture

Percutaneous nephrolithotomy – the puncture

Robot-Assisted Fluoroscopy Versus Ultrasound-Guided Renal Access for Nephrolithotomy: A Phantom Model Benchtop Study

Automated Needle Targeting (ANT) Device-Assisted Renal Access during Percutaneous Nephrolithotripsy (PCNL) Puncture: A Pilot Study to Assess the Safety and Efficacy of a Novel Technique

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