You have accessJournal of UrologyCME1 May 2022MP41-15 PCNL ACCESS PLANNING USING A NOVEL OPTIMIZATION ALGORITHM Moiz Khan, Filipe De Carvalho Pedrosa, Lexuan Wang, Borna Dabiri, Rajni Patel, Jayender Jagadeesan, and Dianne Sacco Moiz KhanMoiz Khan More articles by this author , Filipe De Carvalho PedrosaFilipe De Carvalho Pedrosa More articles by this author , Lexuan WangLexuan Wang More articles by this author , Borna DabiriBorna Dabiri More articles by this author , Rajni PatelRajni Patel More articles by this author , Jayender JagadeesanJayender Jagadeesan More articles by this author , and Dianne SaccoDianne Sacco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002607.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our objective is to evaluate a novel algorithm to assist with renal calyx access planning for percutaneous nephrolithotomy (PCNL). METHODS: An optimization algorithm was developed that determines the optimal skin access and trajectory to calyx/stone for PCNL procedures. The algorithm generated renal access takes into consideration the patient-specific organs, location and size of the stone, calyceal anatomy, access length from the skin to calyx and the trajectory to the ureteropelvic junction (UPJ). To validate the algorithm, 4 urologists and 4 radiologists were asked to provide their preferred access for 15 PCNL procedures based on the diagnostic CT images, and then score the algorithm proposed renal access using a rating scale as 1 (unacceptable), 2 (acceptable and as good as an expert solution) or 3 (better than expert solution). RESULTS: The optimization algorithm solution was rated by experienced experts to be just as good or better than the preferred renal access in 92% of cases, giving an average rating of 2.6 out of 3 (between acceptable and better than expert solution). The average difference between the stone/calyx access point when comparing the expert and algorithm was 1.1 cm (std=0.8 cm) in the medio-lateral direction, 1.3 cm (std=0.5 cm) in the anterio-posterior direction, and 2.8 cm (std=1.6 cm) in the cranio-caudal direction. The distance between the percutaneous access was 2.8 cm (s=1.7 cm) in the medio-lateral direction, 2.3 cm (std=1.6 cm) in the anterio-posterior direction, and 6.6 cm (std=3.2 cm) in the cranio-caudal direction. Experts had an average tract length of 83.7 mm, compared to 87.9 mm by the algorithm and angle of insertion to the ureteropelvic junction of 151.3 deg to 152.3 deg, respectively. There was no significant difference between the experts and algorithm in these findings (p >0.5). CONCLUSIONS: Initial evaluation yielded good performance of the algorithm in specifying a skin access site and trajectory into the calyx when planning a PCNL. The algorithm offers a valuable optimization tool for preoperative surgical planning and verification, and potential resident training tool. Figure Caption: (top) Surgical plan, green line shows the algorithm output. (bottom) Red line is the solution provided by the algorithm and green line is a representative expert solution. Source of Funding: NIH R01DK119268 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e726 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moiz Khan More articles by this author Filipe De Carvalho Pedrosa More articles by this author Lexuan Wang More articles by this author Borna Dabiri More articles by this author Rajni Patel More articles by this author Jayender Jagadeesan More articles by this author Dianne Sacco More articles by this author Expand All Advertisement PDF DownloadLoading ...