Intraoperative use of CT-navigation during percutaneous nephrolitholapaxy with the SIEMENS Healthineers’ ARTIS pheno robotic system

Abstract

Introduction. Percutaneous nephrolitholapaxy (PNL) is the optimal method in the treatment of large or complex renal stones. Surgical equipment and endoscopic equipment, and specialised tools have been constantly developing since the advent of PNL in 1976, increasing success rates with a decrease in the number of complications and morbidity. Owing to the specificity and complexity of the technique, only 11% of urologists in the USA perform PNL, while in Russian Federation no more than 5% of specialists realise it.Objective. To evaluate the possibilities of using a robot-angiograph to create a puncture access.Materials & methods. In the Krasnoyarsk Regional Clinical Hospital in 2021, the first PNL was performed in a patient with a left-sided lower calyx stone using the SIEMENS Healthineers’ ARTIS pheno robotic angiograph in a hybrid operating room.  This robotic installation allows the performing of an intraoperative computed tomography examination followed by the construction of a navigation map with a clearly displayed trajectory, length, and angle of inclination of the needle path with automatic positioning of the C-arm.Results. We performed 30 pyelocaliceal punctures using a robotic angiographic installation for PNL. The average age of patients was 56.6 ± 19.0 years. According to MSCT, the lower calyx stone was detected in seven patients, the middle calyx — 13 cases, the upper calyx — seven patients, pelvic stones were recorded in three patients.  The density of stones varied from 877 HU to 1356 HU.  The use of the ARTIS pheno robotic system allows performing intraoperative 3D modelling to determine the safest pyelocaliceal puncture, followed by PNL, regardless of the stone localisation, the complexity of the anatomy. In addition, a CT-like scans allows you to assess the presence of residual stones during the operation and perform a "second look" not in a delayed manner. This system, unlike all existing types of navigation, allows intraoperative evaluation of the effectiveness (stone-free rate) of surgical treatment.Conclusion. The introduction of this navigation system in PNL will minimise the risks of complications from puncture access, reduce the number of repeated interventions, and minimise undesirable consequences in the postoperative period.