MP04-08 ROBOTIC-ASSISTED FLUOROSCOPIC GUIDANCE PROVIDES MORE ACCURATE AND CONFIDENT RENAL ACCESS THAN ULTRASOUND GUIDANCE

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INTRODUCTION AND OBJECTIVE: Renal access is the most important step for successful percutaneous nephrolithotomy. Several techniques have been developed to improve the accuracy of renal access; however, using a state-of-the-art technology with artificial intelligence may yield a better feature of completely automated puncture. To evaluate the feasibility of robotic-assisted fluoroscopic-guided (RAG) puncture, we compared RAG, using a novel robot system for percutaneous renal access with ultrasound-guided (USG) puncture. METHODS: We conducted a benchtop study with a renal phantom model using the Automated Needle Targeting with X-ray method. In total, 17 urologists participated in this study and performed RAG and USG phantom punctures with or without needle guide attachment. The number of punctures, time required for a device set-up, needle puncture, and fluoroscopic exposure were recorded for analyses. RESULTS: The single-puncture success rates of the RAG and USG puncture were 100% and 70.6%, respectively (p = 0.021). The median needle puncture time of RAG was 24% shorter than that of USG ( 35.0 vs. 46.0 seconds; p < 0.001), and the median device set-up time for RAG was a minute longer than that for USG ( 93.0 vs. 30.5 seconds; p < 0.001). The median duration of fluoroscopic exposure in RAG was longer than that in USG (38.0 vs. 6.5 seconds; p < 0.001) (Table 1). The surgeon’s self-assessments demonstrated that the participating urologist felt better visibility, safer, and more satisfied with RAF than with USG punctures. A sub-analysis revealed that attending physicians required a shorter total procedure time than did residents, in the RAG group (p = 0.045). Moreover, the needle insertion analysis of phantom models in the dry lab revealed that the heterogeneity of insertion angles was related to target failure by USG puncture. CONCLUSIONS: Our study revealed that although RAG and USG punctures had comparable performance, RAG puncture was safer and more accurate than USG puncture for renal access.Source of Funding: None