背景:这项研究评估了在经皮肾镜取石术(PCNL)中使用立体定向光学导航结合锥形束CT(CBCT)成像获得单次尝试进入骨盆系统的可行性。
方法:有PCNL适应症的患者被前瞻性纳入IRB批准的研究。无菌制备后,基准标记贴在患者皮肤上。获得了初始的过程中CBCT扫描,泌尿科医生使用导航软件规划针头轨迹。在核实没有穿过关键结构后,导针器与计划一致.将针通过针引导手动插入到指示的深度,并且执行第二次CBCT扫描以确认针位置。两者,扫描和针头插入,在呼吸暂停下进行。这项研究评估了技术成功,准确度,程序时间,并发症发生率,和辐射剂量。
结果:在2022年6月至2023年4月之间,包括7名患者。在所有患者中,导航系统允许安全穿刺。然而,技术成功率仅为29%。在42%的案例中,骨盆的进入是通过一个小的手动调整来实现的。剩下的29%,根据临床标准缩回并定位针头.针与靶之间的平均偏差为5.9±2.3mm。平均总手术时间为211±44分钟。平均辐射暴露量为6.4mSv,CBCT扫描占这种暴露的82%。
结论:光学导航系统促进了安全的针头插入,但不能始终如一地确保PCNL的精确的一次性针头定位。实时可视化和轨迹校正可以提高技术成功率。
BACKGROUND: This study assessed the feasibility of acquiring single-attempt access to the pelvicalyceal system during percutaneous nephrolithotomy (PCNL) using stereotactic optical navigation combined with cone-beam CT (CBCT) imaging.
METHODS: Patients with a PCNL indication were prospectively included in this IRB approved study. After sterile preparation, fiducial markers were attached to patients\' skin. An initial intraprocedural CBCT scan was acquired, on which the urologist planned the needle trajectory using the navigation software. After verifying that no critical structures were crossed, the needle guide was aligned with the plan. A needle was manually inserted through the needle guide to the indicated depth and a second CBCT scan was performed for needle position confirmation. Both, scanning and needle insertion, were performed under apnea. The study evaluated technical success, accuracy, procedure time, complication rate, and radiation dose.
RESULTS: Between June 2022 and April 2023, seven patients were included. In all patients, the navigation system allowed safe puncture. However, the technical success rate was only 29%. In 42% of the cases, pelvicalyceal access was achieved by a small manual adjustment. In the remaining 29%, the needle was retracted and positioned per clinical standard. The average deviation between the needle and target was 5.9 ± 2.3 mm. The average total procedure time was 211 ± 44 min. The average radiation exposure was 6.4 mSv, with CBCT scanning contributing to 82% of this exposure.
CONCLUSIONS: The optical navigation system facilitated safe needle insertion but did not consistently ensure accurate one-attempt needle positioning for PCNL. Real-time visualization and trajectory correction may improve the technical success rate.