Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy: A Description of Three Novel Ultrasound-Guided Needle Techniques

Chu, Carissa; Masic, Selma; Usawachintachit, Manint; Hu, Weiguo; Yang, Wenzeng; Stoller, Marshall L.; Li, Jianxing; Chi, Thomas

doi:10.1089/end.2015.0185

Cited by 56 publications

(52 citation statements)

References 21 publications

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“…18,19 Briefly, under general anesthesia, a 5-french externalized ureteral catheter was placed into the ipsilateral ureter via a flexible cystoscope for retrograde instillation of iodinated contrast agent or saline as needed. The patient was then repositioned prone and safely secured to the operative table.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy

Hudnall

Usawachintachit

Metzler

et al. 2017

Urology

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Objective To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy (PCNL) and determine which method can be performed at a lower cost per case. Methods A cost comparison study was performed utilizing clinical data from a prospectively maintained research database. We included the most recent 33 consecutive ultrasound-guided PCNL cases in 2016 and the most recent 40 consecutive fluoroscopy-guided PCNL cases before the operative surgeon transitioned to ultrasound guidance in May 2014. Total operative time and clinical outcomes were examined. Costs were extracted from the institution accounting systems and given a uniform multiplier to protect institutional financial reporting confidentiality. Comparisons were made using Student’s t-test and Chi-squared. Results After excluding outliers, 71 PCNL procedures were included in the analysis. Demographic data and stone characteristics were not different between ultrasound-guided and fluoroscopy-guided groups. However, mean operative time for ultrasound-guided PCNL was significantly shorter (99.8±27.0 vs. 144.9±55.1 minutes, p <0.05). Including capital equipment costs, the mean total cost per case of ultrasound-guided PCNL was approximately 30% less than fluoroscopy-guided PCNL (simulated costs with a uniform multiplier; $5,258.90±957.12 vs. $7,508.60±1,163.83, p <0.05). Postoperative clinical outcomes were comparable between the two groups. Conclusion Including capital costs, ultrasound-guided PCNL can produce comparable clinical outcomes to fluoroscopy-guided procedures at a lower cost to the institution. Shorter operative time drives significant savings with the adoption of ultrasound guidance, which may be magnified with increasing case volume. Using ultrasound imaging during PCNL may be more cost-effective compared to fluoroscopy and warrants further study.

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Section: Methodsmentioning

confidence: 99%

Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy

Hudnall

Usawachintachit

Metzler

et al. 2017

Urology

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“…(d)]. The US probe was virtually positioned 6 cm away from the center of the kidney US surface, mimicking the typical distance between kidney and skin, and the center of rotation defined at the probe's tip [Fig. (c)].…”

Section: Methodsmentioning

confidence: 99%

“…Simulation of intraoperative kidney acquisition and segmentation of 2D US images: According to Chu et al, 32 during US-guided PRA, the US probe is typically positioned to capture longitudinal and/or transverse sections of the kidney [Figs. 3(a) and 3(b)].…”

Section: B2 Data Simulationmentioning

confidence: 99%

Surface‐based registration between CT and US for image‐guided percutaneous renal access – A feasibility study

et al. 2019

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Purpose As a crucial step in accessing the kidney in several minimally invasive interventions, percutaneous renal access (PRA) practicality and safety may be improved through the fusion of computed tomography (CT) and ultrasound (US) data. This work aims to assess the potential of a surface‐based registration technique and establish an optimal US acquisition protocol to fuse two‐dimensional (2D) US and CT data for image‐guided PRA. Methods Ten porcine kidney phantoms with fiducial markers were imaged using CT and three‐dimensional (3D) US. Both images were manually segmented and aligned. In a virtual environment, 2D contours were extracted by slicing the 3D US kidney surfaces and using usual PRA US‐guided views, while the 3D CT kidney surfaces were transformed to simulate positional variability. Surface‐based registration was performed using two methods of the iterative closest point algorithm (point‐to‐point, ICP1; and point‐to‐plane, ICP2), while four acquisition variants were studied: (a) use of single‐plane (transverse, SPT; or longitudinal, SPL) vs bi‐plane views (BP); (b) use of different kidney's coverage ranges acquired by a probe's sweep; (c) influence of sweep movements; and (d) influence of the spacing between consecutive slices acquired for a specific coverage range. Results BP view showed the best performance (TRE = 2.26 mm) when ICP2 method, a wide kidney coverage range (20°, with slices spaced by 5°), and a large sweep along the central longitudinal view were used, showing a statistically similar performance (P = 0.097) to a full 3D US surface registration (TRE = 2.28 mm). Conclusions An optimal 2D US acquisition protocol was evaluated. Surface‐based registration, using multiple slices and specific sweep movements and views, is here suggested as a valid strategy for intraoperative image fusion using CT and US data, having the potential to be applied to other image modalities and/or interventions.

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“…We have previously published details regarding surgical technique. 8,13 Before moving the patient to a prone position, we placed a 5-French externalized ureteral catheter into the ipsilateral ureter via a flexible cystoscope for retrograde instillation of saline to dilate the kidney as needed. We used a 3.5-MHz convex abdominal transducer (Hitachi Aloka Medical America, Wallingford, CT) to localize the stone position as well as the collecting system anatomy.…”

Section: Methodsmentioning

confidence: 99%

X-ray–free Ultrasound-guided Percutaneous Nephrolithotomy: How to Select the Right Patient?

Usawachintachit

Tzou

et al. 2017

Urology

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OBJECTIVE To identify factors associated with successful ultrasound guidance for each surgical step of ultrasound-guided percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Consecutive patients undergoing PCNL between March 2015 and June 2016 were prospectively enrolled. An attempt was made to use ultrasound guidance in renal access, tract dilation, and nephrostomy tube placement for each patient. For steps during which ultrasound guidance was unsuccessful, fluoroscopic screening was applied. Regression analysis identified patient characteristics associated with successful use of ultrasound guidance. RESULTS A total of 96 patients composed this cohort, with a mean body mass index of 28.7 kg/m2. Mean stone size was 33.1 ± 18.9 mm, and no hydronephrosis was found in 63.5% of cases. Fluoroscopic screening was required for renal access in 27 cases (28.1%), tract dilation in 38 (39.6%), and nephrostomy tube placement in 80 (83.3%). Multivariate analysis demonstrated that successful ultrasound guidance was significantly associated with the presence of hydronephrosis for renal access and the absence of staghorn calculi for tract dilation. Ultrasound-guided nephrostomy tube placement appeared linked to surgeon experience. CONCLUSION To achieve completely x-ray–free ultrasound-guided PCNL, the ideal patient should have a hydronephrotic collecting system with no staghorn stone present. For practitioners looking to adopt ultrasound guidance into their PCNL practice, these represent the most appropriate patients to safely initiate a surgical experience.

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Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy: A Description of Three Novel Ultrasound-Guided Needle Techniques

Cited by 56 publications

References 21 publications

Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy

Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy

Surface‐based registration between CT and US for image‐guided percutaneous renal access – A feasibility study

X-ray–free Ultrasound-guided Percutaneous Nephrolithotomy: How to Select the Right Patient?

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