Precise Puncture Research Articles

Comparison of strategies based on DTI visualisation for stereotactic minimally invasive surgery in the treatment of moderate-volume thalamo-basal ganglia cerebral haemorrhage: a protocol for a multicenter prospective study

IntroductionHypertensive intracerebral hemorrhage (HICH) is a condition associated with significant morbidity, mortality, and disability, particularly among the elderly population. The management of moderate thalamic-basal ganglia cerebral hemorrhage primarily relies on conservative approaches. Nevertheless, the rate of long-term disability remains high. In recent years, there has been significant advancement in minimally invasive surgery and diffusion tensor imaging techniques. Consequently, the utilization of Diffusion Tensor Imaging (DTI) technology in patients with cerebral haemorrhage allows for the identification of the haematoma’s location in relation to the Corticospinal Tract (CST). This enables the development of precise puncture pathways that can be visualized, thereby avoiding any potential damage to the CST.Methods and analysisDiffusion Tensor Imaging (DTI) is a method used to assess the structural and physiological characteristics of biological tissue by examining the diffusion behavior of water molecules.In the central nervous system, limb paralysis will be inevitable if the corticospinal tract is damaged. By employing DTI imaging techniques on individuals, it becomes possible to visualize the spatial relationship between the hematoma and the CST. This approach allows avoidance of the CST during preoperative planning of the puncture path, thus reducing secondary injuries caused by the procedure. The primary objective of this study was to assess the ability of patients in the minimally invasive surgery group and the conservative group to perform activities of daily living after 6 months of treatment. In addition, secondary outcomes included assessment of hematoma resorption/clearance ratios, cytokine levels, complication rates, and therapeutic indexes at different treatment durations, as well as long-term safety and efficacy at 2–3 years of follow-up. Furthermore, subgroup analysis, and sensitivity analysis were conducted to further analyze the data. Logistic single-variate and multivariate regression analyses were applied to understand the adverse factors affecting prognosis.Ethics and disseminationThe clinical study was reviewed and approved by the Ethics Committee of the First People’s Hospital of Yibin. The ethical number is: 2023 Review (64).Registration numberThis protocol is registered in the Prospective Registry of Chinese Clinical Trial Registries (PROCCTR). The full date of first registration is 28/12/2023. The registration number for PROCCTR is ChiCTR2300079252.

Finite element analysis of precise puncture vertebral augmentation in the treatment of different types of osteoporotic vertebral compression fractures

BackgroundOsteoporosis vertebral compression fracture (OVCF) secondary to osteoporosis is a common health problem in the elderly population. Vertebral augmentation (VA) has been widely used as a minimally invasive surgical method. The transpedicle approach is commonly used for VA puncture, but sometimes, it is limited by the anatomy of the vertebral body and can not achieve good surgical results. Therefore, we propose the treatment of OVCF with precise puncture vertebral augmentation (PPVA). This study used finite element analysis to explore the biomechanical properties of PPVA in the treatment of osteoporotic vertebral compression fractures (OVCFs) with wedge, biconcave, and collapse deformities.MethodThree-dimensional finite element models of the fractured vertebral body and adjacent superior and inferior vertebral bodies were established using Computed Tomography (CT) data from patients with OVCF, both before and after surgery. Evaluate the stress changes of the wedged deformed vertebral body, biconcave deformed vertebral body, collapsed deformed vertebral body, and adjacent vertebral bodies before and after PPVA.ResultIn vertebral bodies with wedge deformity and collapsed deformity, PPVA can effectively reduce the stress on the vertebral body but increases the stress on the vertebral body with biconcave deformity. PPVA significantly decreases the stress on the adjacent vertebral bodies of the wedge deformed vertebral body, and decreases the stress on the adjacent superior vertebral body of biconcave deformity and collapsed deformed vertebral bodies, but increases the stress on the adjacent inferior vertebral bodies. PPVA improves the stress distribution of the vertebral body and prevents high-stress areas from being concentrated on one side of the vertebral body.ConclusionPPVA has shown positive surgical outcomes in treating wedge deformed and collapsed deformed vertebral bodies. However, its effectiveness in treating biconcave vertebral body is limited. Furthermore, PPVA has demonstrated favorable results in addressing adjacent superior vertebral body in three types of fractures.

A single institution experience of the Manta closure device in endovascular aortic repair.

Majority of EVAR procedures are performed with percutaneous arterial access, unless there is severe steno-occlusive disease in the common femoral arteries (CFA). We present our experience of using MANTA closure device with a retrospective evaluation of its safety and efficacy, in the elective setting, and in the emergent setting for ruptured aortic aneurysm. Between Feb 2021 and May 2023 a total of 75 EVAR procedures were closed with a Manta device. Data was collected prospectively and analysed retrospectively. In 75 patients, 128 CFAs were closed with a Manta closure device including 4 emergent ruptured aneurysms. 67 male and 8 female patients with a median age of 77 years had percutaneous EVAR using Manta as a closure device. 128 CFAs were closed with Manta closure device. 3% (4/128) had deployment failures, with three requiring surgical cut down and closure. In one patient, a second Manta device deployment achieved satisfactory haemostasis. Three deployments were complicated by pseudoaneurysms of the CFA, all requiring no further interventions/treatment. No death related to severe haemorrhage from device failure. The pre- and post-procedure CFA puncture site AP diameter was recorded in a total of 106 cases with appropriate follow-up. 66% of these (70/106) had no reduction in CFA diameter post Manta closure. 34% (36/106) had some reduction of vessel AP size CFA post EVAR. No adverse features or further treatment was required due to reduction of vessel diameter in these cases (ongoing yearly surveillance). Manta closure device is safe and easy to deploy with an overall success rate of 97%. There is a short learning curve. Ultrasound assessment and precise puncture at the healthy section of femoral artery are the key to achieve successful haemostasis with Manta closure device. Our findings suggest there is an association of non-clinically significant mild reduction in CFA vessel AP diameter post Manta closure device, which does not require further intervention.

Handheld interventional ultrasound/photoacoustic puncture needle navigation based on deep learning segmentation.

Interventional ultrasound (US) has challenges in accurate localization of the puncture needle due to intrinsic acoustic interferences, which lead to blurred, indistinct, and even invisible needles in handheld linear array transducer-based US navigation, especially the incorrect needle tip positioning. Photoacoustic (PA) imaging can provide complementary image contrast, without additional data acquisition. Herein, we proposed an internal illumination to solely light up the needle tip in PA imaging. Then deep-learning-based feature segmentation alleviates acoustic interferences, enhancing the needle shaft-tip visibility. Further, needle shaft-tip compensation aligned the needle shaft in US image and the needle tip in the PA image. The experiments on phantom, ex vivo chicken breast, preclinical radiofrequency ablation and in vivo biopsy of sentinel lymph nodes were piloted. The target registration error can reach the submillimeter level, achieving precise puncture needle tracking ability with in-plane US/PA navigation.

A novel method of ultrasound-guided positive staining using indocyanine green fluorescence in laparoscopic anatomical liver resection of segments VII and VIII.

Recently, in many Asian centers, laparoscopic anatomical liver resection (LALR) using the indocyanine green (ICG) fluorescence imaging technique has been increasingly applied in resecting hepatocellular carcinoma, even in colorectal liver metastases. However, LALR techniques have not been fully standardized, especially in right superior segments. Due to the anatomical position, prevailing positive staining using a PTCD (percutaneous transhepatic cholangial drainage) needle was superior to negative staining in right superior segments hepatectomy, while it was difficult to manipulate. Herein, we design a novel method of ICG-positive staining for LALR of right superior segments. Between April 2021 and October 2022, we retrospectively studied patients in our institute who underwent LALR of right superior segments using a novel method of ICG-positive staining, which comprised a customized puncture needle and an adaptor. Compared to the PTCD needle, the customized needle was not limited by the abdominal wall and could be punctured from the liver dorsal surface, which was more flexible to manipulate. The adapter was attached to the guide hole of the laparoscopic ultrasound (LUS) probe to ensure the precise puncture path of the needle. Guided by preoperative three-dimensional (3D) simulation and intraoperative laparoscopic ultrasound imaging, we punctured the transhepatic needle into the target portal vein through the adaptor and then slowly injected 5-10ml of 0.025 mg/ml ICG solution into the vessel. LALR can be guided by the demarcation line under fluorescence imaging after injection. Demographic, procedural and postoperative data were collected and analyzed. In this study, 21 patients underwent LALR of the right superior segments with ICG fluorescence-positive staining, and the procedures had a success rate of 71.4%. The average staining time was 13.0 ± 6.4min, the operative time was 230.4 ± 71.7min, R0 resection was 100%, the postoperative hospital stay was 7.1 ± 2.4 days, and no severe puncture complications occurred. The novel customized puncture needle approach seems to be feasible and safe for ICG-positive staining in LALR of right superior segments, with a high success rate and a short staining time.

Vascular anatomy-based localization of intervertebral discs assisting needle puncture for constructing a mouse model of mechanical injury-induced lumbar intervertebral disc degeneration

Intervertebral disc degeneration (IDD) may be the primary cause of low back pain. Potential therapeutics for IDD must be validated in animal models, and their effectiveness quantified using functional metrics. Needle puncture of intervertebral discs (IVDs) has been used to induce IDD in mice and rats. Due to operational challenges, most animal IDD models are constructed using needle puncture of the caudal IVDs in mice, or by using larger animals, such as rats and rabbits. However, mouse IDD models involving lumbar IVD puncture are preferable because mice are genetically similar to humans and are the most commonly used transgenic animals, and because human IDD commonly affects the lumbar spine. We constructed a needle puncture-based mouse IDD model that relies on vascular anatomy to pinpoint lumbar IVDs. We evaluated the morphological and molecular changes in this model by using radiological, pathological, and immunostaining examinations. In our mechanical injury-induced IDD model, lumbar IVDs were accurately localized by injecting colored perfusates into the common iliac artery and vein, and right iliolumbar vein, which helped to visualize puncture positions, avoid neuromuscular injury, shorten the operation time, and decrease bleeding. Nucleus pulposus cells, defined by Krt19, and the disc height index gradually decreased after the surgery, and the degenerative effects peaked at 1 week. In conclusion, we established a mouse IDD model by performing precise puncture of lumbar IVDs via the ventral anterior approach assisted by vessel position. Our model effectively simulated the effects of IDD, and may serve as an efficient research tool.

3D Imaging Segmentation and 3D Rendering Process for a Precise Puncture Strategy During PCNL - a Pilot Study.

Percutaneous nephrolithotomy (PCNL) is frequently used as the first-line treatment of large and complex stones. The key point for successful complex stone removal with minimal risk of complications is to establish the most appropriate access route. Understanding the three-dimensional (3D) relationship of kidney stones and renal collecting systems is crucial for planning and creating an optimal access route. By using a 3D volume segmentation tool a more accurate approach to the renal collecting system and stone treatment could be planned. The objective of this study was assessing the impact of 3D software in getting the desired access.

Clinical and Radiologic Outcomes of Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Comparative Study

Making surgery as less aggressive as possible is best for elderly patients with osteoporotic vertebral compression fractures (OVCFs). Recently, we attempted a more precise, minimally invasive, and robot-assisted kyphoplasty in our clinical setting. We sought to compare the clinical and radiologic outcomes of robot-assisted percutaneous kyphoplasty (rPKP) with those of fluoroscopy-assisted percutaneous kyphoplasty (fPKP) in treating OVCFs. We retrospectively reviewed the clinical and radiologic data of patients with single-segment OVCF who received either rPKP or fPKP between January 2020 and December 2020 at our institution. The operation time, injected volume of cement, length of hospital stays, visual analog scale for back pain, Oswestry Disability Index, local kyphosis angle (LKA), height of fractured vertebra (HFV), and perioperative complications were compared between the 2 groups. A total of 212 cases were included in this study, among whom 81 cases received rPKP and 131 cases received fPKP. Both techniques exhibited satisfying improvement in pain relief and radiologic outcomes. Specifically, the rPKP costed less operation time and achieved better correction and maintenance regarding LKA, HFV, and instant pain relief (P < 0.05). The length of hospital stays, incidence of cement leakage, visual analog scale for back pain, and Oswestry Disability Index at final follow-up were comparable between 2 groups. rPKP provides a precise puncture and exhibits superiority in the correction and maintenance of LKA and HFV when compared with traditional fPKP. The cost-effectiveness and specific application scenarios of this technique shall be confirmed via further extensive studies.

A Novel Rat Tail Needle Minimally Invasive Puncture Model Using Three-Dimensional Printing for Disk Degeneration and Progressive Osteogenesis Research.

Many studies focused on the annulus fibrosus (AF) injury in rodent tail model for the intervertebral disk degeneration (IDD) research. However, previous studies caused tremendous injury of intervertebral disk (IVD) by penetrating whole disk. This study aimed to build a progressive IDD rodent tail model by a novel device for precise and minimally invasive puncture in AF. A precise puncture device was customized by 3D Printing Technique. 40 rodent tail IVDs were randomly grouped as follows: group A, non-puncture; group B, annulus needle puncture (ANP) for 4 week; group C, ANP for 8 week; and group D, ANP for 12 week. Pre- and post-puncture IVD height on radiographs and IVD signal intensity on T2 magnetic resonance imaging (MRI) were measured. Average bone density (ABD) on the end of coccygeal vertebrae between punctured disk was measured on the radiographs. Hematoxylin and eosin, TUNEL staining methods, immunofluorescence for cleaved-caspas3 and immunohistochemistry for aggrecan and collagen II were performed. Progressively and significantly increasing IVD height loss and degenerative grade were observed following the time points. The ABD was respectively, 81.20 ± 4.63 in group A, 83.93±3.18 in group B, 92.65 ± 4.32 in group C, 98.87 ± 6.69 in group D. In both group C and group D, there were significant differences with group A. In histology, increasing number of AF cells was noted in group B. In both group C and D, the fissures in AF were obviously observed, and a marked reduction of AF cells were also observed. In all ANP groups, there were significant decrease in number of NP cells, as well as aggrecan and collagen II contents. TUNEL assay showed cellular apoptosis were stimulated in all puncture group, especially in group D. A progressive IDD rat model could be standardly established by the micro-injury IVD puncture using a novel 3D printing device. This animal model provided a potential application for research of progressive hyperosteogeny following IDD development.

Application of Three-dimensional Visualization Fused with Ultrasound\xa0for Percutaneous Renal Puncture

We present here the three-dimensional (3D) visualization fused with ultrasound and to evaluate its clinical application effect preliminarily. One hundred and eighteen patients with renal calculi in our hospital from September 2017 to December 2019 were prospectively randomized into two groups. The experimental group was treated with percutaneous renal puncture guided by the 3D visualization fused with ultrasound. The control group was treated with percutaneous renal puncture guided by B-ultrasonography (B-US). The puncture time in the experimental versus control group was 4.36 ± 1.28 min versus 10.72 ± 2.94 min (P = 0.000), operation time was 65.85 ± 10.63 min versus 81.34 ± 12.52 min (P = 0.000), and the loss of hemoglobin was 8.55 ± 3.76 g/L min versus 13.33 ± 5.81 g/L(P = 0.000), and the success rate of establishing the channel at one time was 98.41% versus 81.82% (P = 0.002), and the coincidence rate between the channel and the longitudinal axis of the target renal calyx was 88.89% versus 60.00% (P = 0.000). The 3D visualization fused with ultrasound could guide precise puncture to target calyces, reduce operation time, bleeding, and difficulty of puncture.

Towards quantitative and intuitive percutaneous tumor puncture via augmented virtual reality.

In recent years, the radiofrequency ablation (RFA) therapy has become a widely accepted minimal invasive treatment for liver tumor patients. However, it is challenging for doctors to precisely and efficiently perform the percutaneous tumor punctures under free-breathing conditions. This is because the traditional RFA is based on the 2D CT Image information, the missing spatial and dynamic information is dependent on surgeons' experience. This paper presents a novel quantitative and intuitive surgical navigation modality for percutaneous respiratory tumor puncture via augmented virtual reality, which is to achieve the augmented visualization of the pre-operative virtual planning information precisely being overlaid on intra-operative surgical scenario. In the pre-operation stage, we first combine the signed distance field of feasible structures (like liver and tumor) where the puncture path can go through and unfeasible structures (like large vessels and ribs) where the needle is not allowed to go through to quantitatively generate the 3D feasible region for percutaneous puncture. Then we design three constraints according to the RFA specialists consensus to automatically determine the optimal puncture trajectory. In the intra-operative stage, we first propose a virtual-real alignment method to precisely superimpose the virtual information on surgical scenario. Then, a user-friendly collaborative holographic interface is designed for real-time 3D respiratory tumor puncture navigation, which can effectively assist surgeons fast and accurately locating the target step-by step. The validation of our system is performed on static abdominal phantom and in vivo beagle dogs with artificial lesion. Experimental results demonstrate that the accuracy of the proposed planning strategy is better than the manual planning sketched by experienced doctors. Besides, the proposed holographic navigation modality can effectively reduce the needle adjustment for precise puncture as well. Our system shows its clinical feasibility to provide the quantitative planning of optimal needle path and intuitive in situ holographic navigation for percutaneous tumor ablation without surgeons' experience-dependence and reduce the times of needle adjustment. The proposed augmented virtual reality navigation system can effectively improve the precision and reliability in percutaneous tumor ablation and has the potential to be used for other surgical navigation tasks.

Comparison of targeted percutaneous vertebroplasty and traditional percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures in the elderly

ObjectiveTo investigate the clinical effect of precise puncture and low-dose bone cement in percutaneous vertebroplasty (PVP).MethodsSixty patients with osteoporotic vertebral compression fracture (OVCFs) who were treated with PVP in our hospital from July 2018 to June 2019. These included patients were divided into group A (N = 30) and group B (N = 30). Group A has punctured to the fracture area accurately and injected with a small dose of bone cement, the group B was injected with a conventional dose of bone cement. The operation time, the amount of bone cement injection, the number of X-rays, the VAS scores, the leakage rate of bone cement, and the incidence of adjacent vertebral fractures were compared between the two groups.ResultThe operation time, fluoroscopic times, and bone cement volume in group A are less than that in group B (P < 0.05). Patients in group A had a lower incidence of cement leakage and adjacent vertebral fracture than that in patients in group B. There was no significant difference in postoperative pain relief between the two groups.ConclusionsPrecise puncture and injection of small doses of bone cement can reduce the number of X-ray fluoroscopy, operation time, amount of bone cement injection, reduce the rate of bone cement leakage and the incidence of adjacent vertebral fractures, which is a safe and effective surgical approach for the treatment for the aged with OVCFs.

Precision Vascular Delivery of Agrochemicals with Micromilled Microneedles (\xb5MMNs)

We demonstrate use of makerspace techniques involving subtractive microtechnologies to fabricate micromilled microneedles (µMMNs) of stainless steel (SS) for precise delivery of agrochemicals into vascular bundles of plant tissue. Precision delivery is of immense importance for systemic pathogen control in specific areas of plant tissue. Optimization of the micromilling allows for selective removal of SS at the microscale and the microfabrication of a 5 × 5 array of µMMNs having both base width and height of 500 µm to enable precise puncture into the stem of citrus saplings. Atomic Absorption Spectroscopy reveals up to 7.5× increase in the uptake of a therapeutic cargo while Scanning Electron Microscopy reveals that specific sites of the vascular bundle; either xylem or the phloem can be uniquely targeted with customized µMMNs. Such rapid and cost-effective customization with intricate designs along with scalability is enabled by makerspace microfabrication. Additionally, a 19 × 20 array of micromilled mesoneedles has been fabricated and affixed to a paint roller as an applicator system for real-world field testing outside the laboratory. Initial results indicate reliable behavior of the applicator system and the technique can be applied to the systemic delivery of agrochemicals while conserving the loss of the agrochemical with increased application efficiency.

Clinical value of ultrasound-guided percutaneous precise puncture and catheter drainage for cervical abscess

Objective To investigate the efficacy and feasibility of ultrasound-guided percutaneous catheter drainage for cervical abscess. Methods The clinical data of 18 patients with cervical abscess treated by percutaneous puncture and catheterization under ultrasound guidance were analyzed retrospectively. Results All of the 18 patients were successfully treated on one round. None of the 18 patients was nerve injury, main vessels injury or dead during the operation. Conclusions Ultrasound-guided percutaneous catheter drainage of neck abscess is safe and effective, and has high clinical application value. Key words: Ultrasonography; Neck; Abscess; Paracentesis

TRUS applications in anal and rectal diseases

Transrectal ultrasound (TRUS), sometimes named endoanal ultrasound, is performed with dedicated endoprobes and in the hands of an experienced user, can represent an indispensable tool in evaluation of anal fistulae and abscesses in the perianal and – rectal region plus staging of anal and rectal cancer. The spatial resolution of TRUS is unsurpassed, however, MRI or CT should be used to provide a complementary overview of the entire region. The anal canal constitutes the distal approximately 4 cm of the bowel system and represents the transition between mucosal lining in the rectum and squamous cell lining of the skin. The ultrasound appearance is dominated by the change in anatomy of the muscular layers of the wall which in this small segment is made up solely of the circular, concentric muscles representing the internal and external anal sphincter. The anal canal is divided into 3 levels relating to the sphincter muscles. In rectum 5 distinctive layers corresponding to the underlying anatomy can be identified with TRUS and correlated to disease. TRUS guided intervention by means of biopsy or drainage can be performed with a rigid US probe as well as with flexible echoendoscopes. The rigid US probe with an end-fire design is optimal for endo-rectal interventions and in most cases can visualize the entire rectum including perirectal structures. With use of a dedicated needle guide mounted on the probe this technique enables precise puncture of most rectal or perirectal target seen on TRUS. TRUS guided biopsy of rectal masses is an important supplement to the conventional endoscopic biopsy if the latter technique does not provide the final diagnosis. Indications are staging of rectal cancer or suspicions of local recurrence. In these cases, a TRUS guided biopsy of the rectal masse with a 1.2 mm needle (18 gauge automatic or semi-automatic biopsy systems) can provide a deep tissue sample that often results in a final histologic diagnosis. In addition, TRUS guided biopsy is an obvious technique to provide histologic or cytologic information about enlarged lymph nodes or other suspicious perirectal masses. TRUS guided drainage of perianal and deep pelvis abscesses or other fluid collections is a safe approach and effective treatment in cases where the transabdominal percutaneous access cannot be utilized because of overlying structures. This technique provides an alternative to other access routes such as transvaginal, transgluteal or transperineal technique Smaller abscesses can often be treated with needle aspiration followed by saline irrigation, whereas larger abscesses may require continuous drainage through a catheter, which can be inserted with Seldinger technique. A preprocedure CT examination of the lower abdomen is recommended to visualize the exact location and size of the abscess in order to optimize drainage strategy.

Collecting system percutaneous access using MR-assisted guidance: first human phantom experience

Objective: Precise renal puncture is an essential but challenging step for successful percutaneous nephrolithotomy. We evaluated the efficiency of a novel real-time navigation system using Mixed Reality(MR) technology for human phantom kidney puncture. Methods: One human kidney phantom underwent MR-assisted percutaneous collecting system puncture. Two punctures were performed by each of 6 surgeons in the randomize selected upper, middle or lower calyces. Outcome measurements were the number of attempts for renal puncture, the time needed to evaluate the trajectory and to perform percutaneous puncture. Results: A total of 12 punctures were performed successfully using MR-Assisted Guidance. Median evaluation time and renal puncture time for the selected calyces was 13 (range 11 to 19) and 19 seconds (range 15 to 44), respectively. One or Two attempts were needed to achieve a successful renal puncture for all of the surgeons. Conclusions: The proposed MR-assisted guidance solution for renal collecting system puncture proved to be accurate, simple and quick. The inherent limitations of traditional X - ray and ultrasonic technology can be overcome.

Multi-tract Percutaneous Nephrolithotomy approach

Percutaneous nephrolithotomy is still considered as first line treatment for large stones; there is no doubt that for staghorn stones it is a gold standard. From its beginning it underwent many changes and developments. However, there are specific technical aspects, that remain stable throughout the years: Obtaining the precise, planed and desired access to a specific calyx, precise puncture technique and proper tract formation, along with careful introduction of most suitable equipment, are key elements in all percutaneous procedeures, especially in complex cases. Complex cases are not only associated with the aforementioned, along with the number and sites of puncture, but also with the duration of the whole procedure. Although, the approach selection is case-dependent, there are two steps with established role in all cases: puncture and tract formation along with safety. In the present study we overview multitract PNL key steps.

Causes of bleeding due to arterial injury after minimally invasive percutaneous nephroclithotomy

Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL). Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012, and January 2017, in our hospital. Among them, 1 853 were male and 1 127 were female. Age from17 to 76 years old, average age was (45.7±24.1) years. The calculi size was from 1.5 to 4.2 cm, average of (2.62±1.08)cm. There were 2 478 kidney stones and 502 cases of ureteral calculi. Besides, 727 cases with mild hydronephrosis, 1 971 cases with moderate hydronephrosis, 282 cases with severe hydronephrosis; 480 patients with urinary tract infection; 103 patients with renal empyema or acute renal failure; 63 patients with cardiovascular and cerebrovascular stent implantation; 214 patients with diabetes mellitus. Results In this study, all of the patients were established percutaneous renal tract successfully, indwelling drainage tube (6±2)d, and postoperative hemorrhage in 117 cases, of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury, 5 cases with pseudo-aneurysm, and 4 cases with arteriovenous fistula. However, all these cases were rehabilitated after the treatment of super-selective renal artery embolization. The rates of arterial injury of renal calyx access and pelvic access were 0.39% (10/2 535) and 4.27% (19/445), respectively. The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P 0.05). All the percutaneous renal accesses were dilated with Amplatz sheaths, and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35% (5/1 446), 0.46% (5/1 089), respectively, with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P>0.05). The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98% (5/253) and 7.29% (14/192), respectively. There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P 0.05). Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury. Key words: Percutaneous nephrolithotomy; Rate of arterial injury; Super-selective renal artery embolization; Precise puncture

Individualized laparoscopic B-ultrasound-guided microwave ablation for multifocal primary liver cancer.

IntroductionLiver cancer is one of the most common malignancies of the digestive system. Minimally invasive ablation procedures have become one of the major means for treating unresectable multifocal liver cancer and have been extensively applied in primary and metastatic liver cancer treatment. Laparoscopic B-ultrasound-guided microwave ablation is an example of the progress made in this field.AimTo analyze and summarize the results of and experience with laparoscopic B-ultrasound-guided microwave ablation for multifocal primary liver cancer; moreover, the ablation effects were compared between tumors of different sizes.Material and methodsLaparoscope-guided needle ablation was conducted on 84 lesions from 32 patients with primary liver cancer based on tumor size, quantity, and location. Moreover, the perioperative data, ablation effects according to tumor size, and long-term follow-up results were analyzed.ResultsAmong the 84 nodules treated via microwave ablation, tumors measuring ≤ 3 cm demonstrated complete ablation upon imaging analysis conducted 1 month after surgery. Moreover, 5 of the tumors measuring > 3 cm demonstrated incomplete ablation. In these cases, a second procedure was performed, until imaging studies confirmed that complete ablation was achieved.ConclusionsLaparoscopic microwave ablation allows for precise puncture positioning, an effective ablation range, and safe and feasible surgery, which is especially suitable for liver tumors located in sites difficult to access.

Three-dimensionally printed personalized guide plate for percutaneous radiofrequency thermal coagulation in idiopathic trigeminal neuralgia

Radiofrequency thermocoagulation (RFT) is used widely for the treatment of idiopathic trigeminal neuralgia (TN). Precise puncture and placement of the electrode needle tip are crucial for successful RFT. This technical note introduces a novel method for performing RFT using a customized, three-dimensionally (3D)-printed guide plate. Eleven patients with idiopathic TN were treated using this method between February and July 2016. Three had V2 branch TN and eight had V3 branch TN. Punctures in eight patients were successful at the first attempt; slight adjustments were required subsequently in the other three patients. The puncture time in all cases was less than 1min. The patients reported pain relief immediately after RFT, and no complications were observed in any patient. Thus, the customized 3D-printed guide plate offers the advantages of precise placement of the puncture needle and minimal complications.