EAU 2018: SabreSource: A Novel Percutaneous Nephrolithotomy Apparatus to Aid Collecting System Puncture - A Preliminary Report

Copenhagen, Denmark (UroToday.com) Dr. Moore, clinical urologist from the Groote Schuur Hospital in Cape Town, South Africa, presented her experience on the use of a novel device to facilitate nephrostomy puncture access during percutaneous nephrolithotomy (PCNL). To begin her presentation, Dr. Moore reiterated the cruciality of an accurate puncture to the surgeon’s preferred calyx. The learning curve for this procedure is excessively difficult, requiring some new surgeons to experience 60-100 cases before proficiency is obtained. It was also reported that only 11% of American Urologists obtain percutaneous access themselves, as they often rely on the radiologists to create the puncture before the case begins. To facilitate with this problem, a novel image guidance system known as SabreSource™ was developed with a locator for ease of access for urologists. Dr. Moore describes her center’s initial use of the system and compared the amount of radiation required for successful puncture while using the device versus conventional techniques. 

In common practice, urologists and radiologists often use the fluoroscopic guided bulls-eye technique. With the SabreSource™ locator device, fluoroscopic screening times (FST) have been shown to be decreased in comparison to the freehand method. The device operates by mounting to a C-arm to offer real time image guidance. The device employees a targeting system with crosshairs and a laser beam to precisely align a nephrostomy needle to the puncture site of choice. For further reassurance of accuracy, the needle itself is fitted with a collimator which lights up when the needle is perfectly aligned. To test the efficacy of this device, seven urology surgical trainees with little PCNL experience were recruited. A model kidney was used to test the device in vitro: phantom kidney was filled with stones and contrast and each trainee was asked to gain percutaneous access using both freehand and the SabreSource™ guidance system. 

In this study, both FST and total radiation times were shown to be significantly less by surgical trainees when using the SabreSource™ as opposed to free hand percutaneous access. This has a very important implication for surgery due to the dangers of fluoroscopy on patient health such as increased risk of leukemia, breast, and skin cancer. The SabreSource™, as quoted by Dr. Moore, is also affordable which may allow the majority of centers to utilize the device. However, before the device can be considered truly efficacious, further clinical studies are needed. 

Presented by: Howlett J. , Lazarus J. , Kaestner L. , Moore A.

Author Information: Groote Schuur Hospital, University of Cape Town, Dept. of Urology, Cape Town, South Africa

Written by: Zachary Valley MD, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark