MP14-18 ROBOTIC-ASSISTED ELECTROMAGNETIC GUIDANCE IMPROVES SUCCESS IN GAINING PERCUTANEOUS ACCESS FOR NEPHROLITHOTOMY BY NOVICES

Abstract

You have accessJournal of UrologyCME1 May 2022MP14-18 ROBOTIC-ASSISTED ELECTROMAGNETIC GUIDANCE IMPROVES SUCCESS IN GAINING PERCUTANEOUS ACCESS FOR NEPHROLITHOTOMY BY NOVICES Mitchell Humphreys, Kevin Wymer, Ben Chew, Janet Zhen, Fuad Elkhoury, Sri Sivalingam, Matthew Dunn, and Michael Borofsky Mitchell HumphreysMitchell Humphreys More articles by this author , Kevin WymerKevin Wymer More articles by this author , Ben ChewBen Chew More articles by this author , Janet ZhenJanet Zhen More articles by this author , Fuad ElkhouryFuad Elkhoury More articles by this author , Sri SivalingamSri Sivalingam More articles by this author , Matthew DunnMatthew Dunn More articles by this author , and Michael BorofskyMichael Borofsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002543.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) offers advantages over retrograde intrarenal surgery for large stone burdens. However, gaining optimal access into the renal collecting system can be challenging and requires advanced training. A minority of PCNL access is currently performed by urologists in the USA. In this study, we evaluate the success of gaining percutaneous renal access in a cadaveric model when using a novel robotic-assisted electromagnetic (EM) guidance platform, compared to fluoroscopic guidance, among individuals that do not regularly perform their own PCNL access. METHODS: Seven novices (individuals who use IR for access, or gain percutaneous access <24 times/year, or have gained access <30 times after training) were asked to use robotic-assisted EM guidance provided by the Monarch® Platform, Urology (Auris Health, Inc., Redwood City, CA) to obtain upper pole, mid-kidney, and lower pole access in a modified-supine position vs. the same tasks in a prone position using fluoroscopy in a cadaveric model. The number of puncture attempts, accuracy (papilla/fornix, infundibulum, or miss), and time to achieve access was compared. Participants were also surveyed on their confidence in gaining access (Likert scale 1-5, 5 as the best score). Statistical comparisons were made using paired t-tests. RESULTS: Novices had increased overall success in gaining percutaneous access using robot-assisted EM navigation compared to fluoroscopy-guided (100% vs. 57%), with greater accuracy (papillary or forniceal) (100% vs. 29%) (Figure 1). Robotic-assisted EM guidance decreased the average number of insertion attempts per calyx (1.24±0.10 vs. 2.98±0.65, p<0.05), and also the time to achieve access (6.92±0.66 min vs. 16.90±3.21 min, p<0.05). Lastly, novices expressed a greater sense of ease [5(3.3-5) vs. 2.5(1-3)] and confidence [5(3.3-5) vs. 2(1-3)] in gaining access using EM- vs. fluoroscopy-guided navigation. CONCLUSIONS: Percutaneous access using robotic-assisted EM-guidance provided by the Monarch® Platform improved access success, time, accuracy, and confidence among study participants. These initial data suggest this novel enabling technology can benefit urologists to routinely gain their own access for PCNL. Source of Funding: Johnson & Johnson © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e239 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell Humphreys More articles by this author Kevin Wymer More articles by this author Ben Chew More articles by this author Janet Zhen More articles by this author Fuad Elkhoury More articles by this author Sri Sivalingam More articles by this author Matthew Dunn More articles by this author Michael Borofsky More articles by this author Expand All Advertisement PDF DownloadLoading ...