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. 2024 Mar 20;42(1):181.
doi: 10.1007/s00345-024-04870-0.

Feasibility of stereotactic optical navigation for needle positioning in percutaneous nephrolithotomy

I M Spenkelink  1 , X Zhu  2 , J J Fütterer  3 , J F Langenhuijsen  2
Affiliations

Feasibility of stereotactic optical navigation for needle positioning in percutaneous nephrolithotomy

I M Spenkelink et al. World J Urol. .

Abstract

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 In the remaining 29%, the needle was retracted and positioned per clinical standard.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.

Keywords: CBCT imaging; Navigated needle positioning; Optical navigation; Percutaneous nephrolithotomy; Stereotactic navigation.

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Conflict of interest statement

J. J. F. reports grants from Siemens Healthineers outside the submitted work. The other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Stereotactic optical navigation for needle guidance in the percutaneous nephrolithotomy procedure. a Overview of the operating room with the patient prepared for cone-beam CT imaging. b Photograph of the fiducial markers on the skin, positioned around the expected needle entry point, and on the aiming device, which is positioned in the needle guide. These markers are used for image-to-patient registration. c Overview of the set-up for optical navigation with the CAS-One IR system. The camera detects the markers on the skin and correlates this with the cone-beam CT scan. The markers are shown as green spheres in the scan. d Using the navigation software, the needle tract is planned by selecting an entry point on skin level and a target point in the selected calyx. e After aligning the aiming device with the planned trajectory, the needle is inserted manually through the needle guide
See this image and copyright information in PMC

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