Ian Ong: Dear viewers, successful percutaneous nephrolithotomy depends on precise calyceal access. Traditional fluoroscopic techniques require significant operator experience and expose both patients and operating room staff to cumulative radiation. To address this, we developed the Bubble Needle, a novel percutaneous access device incorporating a two-dimensional bubble level that enables anterior-posterior alignment after a single fluoroscopic image. We conducted a prospective randomized simulation study involving 21 participants: nine students, five residents, and seven attending physicians. Each performed three renal punctures using traditional bullseye, rotated bullseye, and Bubble Needle techniques in a ballistic gel phantom with a two-millimeter radio-opaque target at 10 centimeters of depth. We measured fluoroscopy dose, fluoroscopy time, procedure time, and targeting accuracy, with analysis using repeated measures ANOVA and mixed effects modeling. A total of 189 punctures were performed.

Performance improved with operate experience. However, the Bubble Needle reduced fluoroscopy dose and time consistently across all levels, allowing less experienced operators to achieve comparable outcomes. Compared to traditional and rotated techniques, the Bubble Needle reduced radiation dose by 74 and 58% and fluoroscopy time by 70% and 53%, respectively. Procedure time was shorter and targeting accuracy was unchanged. In conclusion, the Bubble Needle maintains accuracy while significantly reducing radiation. Thank you.