Remote Percutaneous Renal Access Using a Telesurgical Robotic System

Abstract

Urology is increasingly becoming a technology-driven specialty. With advancing technical expertise and a shift towards minimal invasion in urologic procedures, urologists are looking for ways to improve patient care using robotic and telerobotic surgical systems. Percutaneous renal access is a procedure that is ideally suited to telerobotic control, as it is a complicated task that requires precise control of the access needle through accurate initial placement and insertion without deviation. The URobotics laboratory at Johns Hopkins has developed a system for image-guided percutaneous access. An active and radiolucent needle driver, PAKY (percutaneous access to the kidney), was designed and constructed. This was then combined with the remote center of motion (RCM) robot to enable needle orientation. We describe the development of this robotic percutaneous access system from the initial laboratory trials through local clinical applications to a sequence of transatlantic telerobotic trials that have statistically proven the increased accuracy of the robot over the human hand. This has provided strong qualitative and quantitative data to support remote percutaneous renal access and telerobotic surgery in general.