Pd54-01 using Intraoperative Portable Ct Scan to Minimize Reintervention Rates in Pcnl: A Prospective Trial

Abstract

INTRODUCTION AND OBJECTIVE: Up to 60% of patients undergoing initial percutaneous nephrolithotomy (PCNL) ultimately require further interventions due to residual stone fragments. Portable CT scanning (PCT) can allow cross-sectional imaging to be obtained intraoperativelydrather than post-operativelydallowing surgeons to extract residual stones and reducing the need for subsequent procedures. We sought to evaluate how this technology affects the need for subsequent interventions, length of stay, and radiation dose to the patient.METHODS: We prospectively enrolled all eligible patients undergoing initial PCNL for this trial (n[37), allowing them to undergo a single intraoperative CT-abdomen and ipsilateral antegrade ureteroscopy during initial PCNL. These patients were then compared to a retrospective cohort of all patients undergoing initial PCNL at our institution in 2018-2019 (n[178). We studied their perioperative imaging, intraoperative findings, and postoperative clinical courses. Univariate analysis was performed using chi-squared and student's t-tests.RESULTS: There was no difference between the two cohorts regarding demographic properties, stone characteristics, or location of percutaneous access. Of the patients enrolled, 89% underwent PCT, 52% of PCT scans identified residual fragments prompting continuation of surgery, and 88% of these patients were rendered stone-free within the same operation. The prospective cohort had significantly lower rate of 90-day reintervention (2.7% vs. 31.5%, p<0.01), fewer perioperative complications (0% vs. 9.6%, p[0.049), reduced CTbased radiation dose (975 mGy*cm vs. 511, p<0.01), and shorter length of stay (2.3 vs. 3.4 days, p<0.01). There was no difference in the radiation dose from intraoperative fluoroscopy or lengths of procedure between the two cohorts.CONCLUSIONS: Obtaining an intraoperative portable CT scan during PCNL can offer substantial benefits to both patients and surgeons, such as lower reintervention rate, fewer complications, reduced radiation dose to the patient, and shorter length of stay.