Developing Free Three-dimensional Software for Surgical Planning for Kidney Stones: Volume is Better than Diameter

Panthier, F.; Doizi, Steeve; Illoul, Lounès; Berthe, Laurent; Traxer, Olivier

doi:10.1016/j.euf.2020.06.003

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…In 2018, EMS and Boston Scientific co-developed and launched a dual energy (ultrasonic/ballistic 12 hz)-single probe lithotripter named Trilogy TM . Multiple bench [6] and limited surgical evaluations [7][8][9] have been published demonstrating exceptional lithotripsy potential; however, a comparison to currently utilized lithotrites has not yet been performed. The purpose of this manuscript is to compare Trilogy TM with the ShockPulse-SE system in a prospective randomized multicenter clinical trial.…”

Section: Introductionmentioning

confidence: 99%

Multi-Institutional Prospective Randomized Control Trial of Novel Intracorporeal Lithotripters: ShockPulse-SE vs Trilogy Trial

Large

Nottingham

Brinkman

et al. 2021

Journal of Endourology

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Introduction: Currently, there are multiple intracorporeal lithotripters available for use in percutaneous nephrolithotomy (PCNL). This study aimed to evaluate the efficiency of two novel lithotripters: Trilogy and ShockPulse-SE. Materials and Methods: This is a prospective multi-institutional randomized trial comparing outcomes of PCNL using two novel lithotripters between February 2019 and June 2020. The study assessed objective measures of stone clearance time, stone clearance rate, device malfunction, stone-free rates, and complications. Device assessment was provided through immediate postoperative survey by primary surgeons. Results: There were 100 standard PCNLs completed using either a Trilogy or ShockPulse-SE lithotrite. Using quantitative Stone Analysis Software to estimate stone volume, the mean stone volume was calculated at 4.18 ± 4.79 and 3.86 ± 3.43 cm 3 for the Trilogy and ShockPulse-SE groups, respectively. Stone clearance rates were found to be 1.22 ± 1.67 and 0.77 ± 0.68 cm 3 /min for Trilogy vs ShockPulse-SE ( p = 0.0542). When comparing Trilogy to ShockPulse-SE in a multivariate analysis, total operative room time (104.4 ± 48.2 minutes vs 121.1 ± 59.2 minutes p = 0.126), rates of secondary procedures (17.65% vs 40.81%, p = 0.005), and device malfunctions (1.96% vs 34.69%, p < 0.001) were less, respectively. There was no difference in final stone-free rates between devices. Conclusion: Both the Trilogy and ShockPulse-SE lithotripters are highly efficient at removing large renal stones. In this study, we noted differences between the two devices including fewer device malfunctions when Trilogy device was utilized. Clinical Trial ID number: NCT03959683

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Section: Introductionmentioning

confidence: 99%

Multi-Institutional Prospective Randomized Control Trial of Novel Intracorporeal Lithotripters: ShockPulse-SE vs Trilogy Trial

Large

Nottingham

Brinkman

et al. 2021

Journal of Endourology

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“…We could have also used the characteristics of the ablated crater: deepness, width, length and produced fragments’ size. Consequently, even if our method has been validated by previous in vitro and in vivo studies, we could have analyzed the stone samples using a profilometric method [ 4 , 7 , 9 , 15 , 24 ]. A further dedicated experiment should directly compare both profilometric and three-dimensional segmentation methods.…”

Section: Discussionmentioning

confidence: 99%

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

Panthier

Germain

Gorny

et al. 2021

JCM

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Background: Endocorporeal laser lithotripsy (EL) during flexible ureteroscopy (URS-f) often uses “dusting” settings with “painting” technique. The displacement velocity of the laser fiber (LF) at the stone surface remains unknown and could improve EL’s ablation rates. This in vitro study aimed to define the optimal displacement velocity (ODV) for both holmium:yttrium-aluminium-garnet (Ho:YAG) and thulium fiber laser (Tm-Fiber). Methods: A 50W-TFL (IRE Polus®, Russia) and a 30W-MH1-Ho:YAG laser (Rocamed®), were used with 272µm-Core-Diameter LF (Sureflex, Boston Scientific©), comparing three TFL modes, “fine dusting” (FD:0.05–0.15 J/100–600 Hz); “dusting” (D:0.5 J/30–60 Hz); “fragmentation” (Fr:1 J/15–30 Hz) and two Ho:YAG modes (D:0.5 J/20 Hz, Fr:1 J/15 Hz). An experimental setup consisting of immerged cubes of calcium oxalate monohydrate (COM) stone phantoms (Begostone Plus, Begoã) was used with a 2 seconds’ laser operation time. LF were in contact with the stones, static or with a displacement of 5, 10 or 20 mm. Experiments were repeated four times. Stones were dried and µ-scanned. Ablation volumes (mm3) were measured by 3D-segmentation. Results: ODV was higher in dusting compared to fragmentation mode during Ho:YAG lithotripsy (10 mm/sec vs. 5 mm/sec, respectively). With Tm-Fiber, dusting and fragmentation OVDs were similar (5 mm/sec). Tm-Fiber ODV was lower than Ho:YAGs in dusting settings (5 mm/s vs. 10 mm/sec, respectively). Without LF displacement, ablation volumes were at least two-fold higher with Tm-Fiber compared to Ho:YAG. Despite the LF-DV, we report a 1.5 to 5-fold higher ablation volume with Tm-Fiber compared to Ho:YAG. Conclusions: In dusting mode, the ODVTm-Fiber is lower compared to ODVHo:YAG, translating to a potential easier Tm-Fiber utilization for “painting” dusting technique. The ODV determinants remain unknown. Dynamic ablation volumes are higher to static ones, regardless of the laser source, settings or LF displacement velocity.

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“…Kidney Stone Calculator provides a 3D measurement of the SV by a segmentation process [8]. Although volume is instinctively better than the diameter for the stone burden estimation, previous studies have failed to show that the SV can be used as the new standard [12].…”

Section: Volume Measurement For Kidney Stone Surgical Proceduresmentioning

confidence: 99%

“…The segmentation process inherent to KSC does not calculate a volume based on two-dimensional measurements and a mathematical formula [4,5,15]; rather, it refers to the sum of voxels collected by a manual density scale in a region of interest (ROI) [8,9]. Segmentation has been shown to be effective in quantifying vascular calcifications or muscular mass as predictive factors in carcinologic or noncarcinologic diseases [16][17][18][19].…”

Section: Volume Measurement For Kidney Stone Surgical Proceduresmentioning

confidence: 99%

“…However, several imaging techniques are now available to estimate the exact stone burden. As one of them, "Kidney Stone Calculator" (KSC), has been developed as a free three-dimensional (3D) software for the surgical planning of kidney stone endoscopic procedures [8]. It is an extension of 3DSlicer, a free software platform for medical image computing and 3D visualization [9].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

et al. 2021

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Introduction Kidney Stone Calculator (KSC) is a free, three-dimensional (3D) planning software for flexible ureteroscopy(fURS) with Holmium:YAG(Ho:YAG) endocorporeal lithotripsy (EL). KSC provides the stone volume (SV) and expected duration of lithotripsy (ExDL) estimations based on non-enhanced-CT scan (NECT) DICOM series. We aimed to provide a preclinical and clinical evaluation of KSC. Patients and methods A preclinical evaluation measured the SV by three operators (resident, endourology expert and research engineer) among 17 NECT cases. Between January and March 2020, a multicentric, prospective, observational double-blind clinical evaluation was conducted in patients presenting with renal stones treated with Ho:YAG-EL during fURS and preoperative NECT. Demographic and surgical data were collected. The primary endpoint was a significant median difference between ExDL and EffectiveDL (EfDL). Second, efficiency (J/mm 3 ) and efficacy (mm 3 /min) ratios were calculated. Results The preclinical evaluation showed no significant difference in the SV measurements among operators ( p > 0.05). Pearson and Kendall coefficients of 0.99 and 0.98, respectively, were found. Twenty-six patients were included in the clinical evaluation, with a median age of 55 years. In 66% of cases, there was a single stone located in the lower pole, with a density > 1000 Hounsfield Unit observed in 42% and 85% of cases. A 14% [Q1–Q3 (5.4–24.8); p = 0.36] median difference between ExDL and EfDL was noted, which was greater in the case of lower pole stones with no possible relocation ( p = 0.008). Median values of 17.6 J/mm 3 and 0.4 (0.32–0.56) mm 3 /s EL were also noted. Conclusions Kidney Stone Calculator is a reproducible and accurate software that allows for an estimation of the stone burden and provides an ExDL for URSf. Defining the influencing factors of EL will improve its ExDL. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03671-z.

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Developing Free Three-dimensional Software for Surgical Planning for Kidney Stones: Volume is Better than Diameter

Cited by 10 publications

References 5 publications

Multi-Institutional Prospective Randomized Control Trial of Novel Intracorporeal Lithotripters: ShockPulse-SE vs Trilogy Trial

Multi-Institutional Prospective Randomized Control Trial of Novel Intracorporeal Lithotripters: ShockPulse-SE vs Trilogy Trial

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

Evaluation of a free 3D software for kidney stones’ surgical planning: “kidney stone calculator” a pilot study

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