(UroToday.com) At the 2023 American Urological Association annual meeting, Loma Linda University Medical Center presented a novel methodology for renal access. Alphie Rotinsulu, a fourth-year medical student, presented Laser-Guided Renal Access for Percutaneous Nephrolithotomy (PCNL): A Comparison to Conventional Renal Access. Common methodology utilized by urologists in practice to gain access to renal system are under guidance of fluoroscopy and ultrasound; however, fluoroscopy guidance exposes patients and surgeons to radiation, and ultrasound guidance has a complicated learning curve. A Direct Alignment Radiation Reduction Technique (DARRT) using laser targeting was purposed in this study to compare the conventional fluoroscopy method to gain renal access.
After an appropriate IRB approval, all the patients undergoing PCNL treatment for stone management between January 2017 to June 2022 were retrospectively reviewed. Patients who had an existing nephrostomy tube, and ultrasound-guided access were excluded. Eligible patients were divided into fluoroscopy or DARRT groups. Univariate analysis was conducted with the Wilcoxon Rank Sum test and Pearson's Chi Square test, followed by multivariate analysis with factorial ANOVA, and p-values smaller than 0.05 was marked as statistically significant.
A total of 340 patients received PCNL treatment in the Loma Linda Medical Center, and 245 were eligible based on the study criteria. Patients' age, BMI, ASA score, Charleston comorbidity score, and stone density were similar between the both experimental groups; however, DAART group had a higher percentage of staghorn calculi with a significant p-value. The purposed DARRT technique effectively reduced the median procedural fluoroscopy time compared to conventional fluoroscopy from 175.8 s to 14.1 s (p<0.001). Subsequently, the multivariate analysis was performed which reported that DARRT method was indeed the independent cause to reduce fluoroscopy time.
The presenter concluded his presentation by indicating that DARRT method reduced fluoroscopy time by 92%, and how easily this methodology can be adapted by endourologist, and general urologists. During the poster presentation, Alphie Rotinsulu was asked if in these patients undergoing PCNL, the urologist is in fact the person gaining access to renal system. Presenter response was that in some of the cases, interventional radiologists were the providers who gained access to renal system and that is the reason behind the significantly higher percentage of mean fluoroscopy time in conventional fluoroscopy experimental group.
Presented by: Alphie Rotinsulu, MS-III at Loma Linda University, Medical Center
Written by: Seyedamirvala Saadat, B.S. Research Specialist, Department of Urology, University of California Irvine, @val_Saadat on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023
References:
- 1. Khater N, Shen J, Arenas J, et al. Bench-Top Feasibility Testing of a Novel Percutaneous Renal Access Technique: The Laser Direct Alignment Radiation Reduction Technique (DARRT). J Endourol. 2016;30(11):1155-1160. doi:10.1089/end.2016.0170
- Blair B, Huang G, Arnold D, et al. Reduced fluoroscopy protocol for percutaneous nephrostolithotomy: feasibility, outcomes and effects on fluoroscopy time. J Urol. 2013;190(6):2112-2116. doi:10.1016/j.juro.2013.05.114
- Smith DL, Heldt JP, Richards GD, et al. Radiation exposure during continuous and pulsed fluoroscopy. J Endourol. 2013;27(3):384-388. doi:10.1089/end.2012.0213
- Hajiha M, Baldwin DD. New Technologies to Aid in Percutaneous Access. Urol Clin North Am. 2019;46(2):225-243. doi:10.1016/j.ucl.2019.01.00