Cape Town, South Africa (UroToday.com) Traditional techniques for obtaining percutaneous renal access utilize continuous fluoroscopy. In an attempt to minimize radiation exposure, authors evaluated a novel laser direct alignment radiation reduction technique (DARRT) for percutaneous access and test it in a bench-top model.
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In this randomized-controlled bench-top study, 20 medical personnel obtained renal accesses using both the conventional bullseye technique and the laser DARRT. The primary endpoint was total fluoroscopy time. Secondary endpoints included insertion time, puncture attempts, course corrections, and subjective procedural difficulty. In the laser DARRT, fluoroscopy was used with the C-arm positioned with the laser beam at a 30° angle. The access needle and hub were aligned with the laser beam. Effective caliceal puncture was confirmed with fluoroscopy and direct vision.
A total of 120 needle placements were recorded. Fluoroscopy time for needle access using the laser DARRT was significantly lower than the bullseye technique in all groups as follows: attendings (7.09 vs 18.51 seconds; p < 0.001), residents (6.55 vs 13.93 seconds; p = 0.001), and medical students (6.69 vs 20.22 seconds; p < 0.001). Students rated the laser DARRT easier to use (2.56 vs 4.89; p < 0.001). No difference was seen in total access time, puncture attempts, or course corrections between techniques.
Authors concluded that the laser DARRT reduced fluoroscopy time by 63%, compared with the conventional bull’s eye technique. The least experienced users found the laser DARRT significantly easier to learn. This novel technique seems to be promising and warrants further evaluation.
Written By: Zhamshid Okhunov, MD, University of California, Irvine, USA, Department of Urology
34th World Congress of Endourology and SAUA meeting - November 7-12, 2016 – Cape Town, South Africa