PD36-05 PERCUTANEOUS NEPHROSTOMY FOR DUMMIES: ELECTROMAGNETIC NEEDLE GUIDANCE WITH TRACKED ULTRASOUND SNAPSHOTS IN A SIMULATION MODEL

Abstract

You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-05 PERCUTANEOUS NEPHROSTOMY FOR DUMMIES: ELECTROMAGNETIC NEEDLE GUIDANCE WITH TRACKED ULTRASOUND SNAPSHOTS IN A SIMULATION MODEL Michael Fuoco, Tamas Ungi, Rob Siemens, Gabor Fichtinger, and Darren Beiko Michael FuocoMichael Fuoco More articles by this author , Tamas UngiTamas Ungi More articles by this author , Rob SiemensRob Siemens More articles by this author , Gabor FichtingerGabor Fichtinger More articles by this author , and Darren BeikoDarren Beiko More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2442AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrostomy (PCN) is often required urgently in the context of acute renal failure or urosepsis, and may be performed electively for percutaneous nephrolithotomy (PCNL). Many urologists continue to use fluoroscopic guidance for renal access during PCNL despite the hazardous and cumulative radiation dose. Electromagnetic tracking with tracked ultrasound snapshot (TUSS) guidance has been shown to improve success rates and reduce procedure time in spinal facet joint injections. The objective of this study was to investigate the possible benefit of TUSS technology in a simulation model in novice trainees performing PCN. METHODS Four urology residents with minimal or no prior experience in US-guided PCN participated in this study as operators, using an augmented reality training system called Perk Tutor. Each operator performed two TUSS-navigated procedures and two conventional US-guided procedures in an alternating pattern, with the latter serving as a control. Two operators started with TUSS guidance and two started with US guidance. Data was obtained for total needle motion in tissue, needle insertion attempts, total procedure time, and needle time in tissue. RESULTS TUSS-guided PCN was found to have significantly decreased amount of needle motion in tissue (mean 315 vs 965 mm, p=0.04) and number of attempts (mean 1.13 vs 2.75, p=0.02) when compared to conventional US guided PCN. TUSS-guided PCN also had less needle time in tissue (mean 41 vs 77 seconds, p=0.16) and a shorter procedure time (mean 105 vs 223 seconds, p=0.14), though it was not statistically significant. CONCLUSIONS Electromagnetic needle guidance with TUSS decreases needle motion and number of attempts during PCN in novice trainees. Although not statistically significant likely due to the limited study size, TUSS guidance was associated with shorter procedure time and shorter needle time in tissue compared to conventional US guidance. TUSS may lead to fewer complications in clinical scenarios. Residents inexperienced in US guidance were able to use TUSS effectively, suggesting TUSS adoption would enable a wider range of operators to perform PCN clinically. Further studies are needed with more operators and attempts to fully assess the potential clinical impact of TUSS-guided PCN. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e903 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael Fuoco More articles by this author Tamas Ungi More articles by this author Rob Siemens More articles by this author Gabor Fichtinger More articles by this author Darren Beiko More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...