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

Abstract

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.

Human vs. robot operator error in a needle-based navigation system for percutaneous liver interventions

“…A general review of robotic systems for image-guided interventions can be found in. 23,24 The systems presented for minimally-invasive needle insertion into abdominal organs include those introduced by Su et al, 25 Kim et al, 26 Kettenbach et al 27 and Maurin et al 28 Several papers have been published on the accuracy of medical robots 27-29 as well as on the comparison between conventional and robotic-assisted medical interventions, 25, 30 yet, integration of a medical robot with an existing soft tissue navigation system to reduce the operator error has -to our knowledge -not yet been investigated.…”

Tumor Ablation Treatment Planning Coupled to Robotic Implementation: A Feasibility Study

“…More recently, they have been applied to real-time, percutaneous, image-guided interventions such as fluoroscopically guided nephrostomy tube placement and computed tomography (CT)-guided biopsy and thermal ablation (6,7).…”

Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy

“…It was attached to the side rail of the operating table, and incorporated a radiolucent needle grasping disc at the distal end of the arm (8). The PAKY (percutaneous access to the kidney) system and later PAKY-RCM (remote center of motion) system were improvements on the original design: the passive robotic arm was improved by adding an electronic needle insertion device and the ability to position the needle by remote control (9,10).…”