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A randomized, single-blind clinical trial comparing robotic-assisted fluoroscopic-guided with ultrasound-guided renal access for percutaneous nephrolithotomy.

  • Taguchi, Kazumi1
  • Hamamoto, Shuzo1
  • Okada, Atsushi1
  • Sugino, Teruaki1
  • Unno, Rei1, 2
  • Kato, Taiki1
  • Fukuta, Hidekatsu3
  • Ando, Ryosuke1
  • Kawai, Noriyasu1
  • Tan, Yung Khan4
  • Yasui, Takahiro1
  • 1 Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. , (Japan)
  • 2 Department of Urology, University of California, San Francisco, CA.
  • 3 Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. , (Japan)
  • 4 Urohealth Medical Clinic, Mt Elizabeth Hospital, Novena, Singapore. , (Singapore)
Published Article
The Journal of urology
Publication Date
May 13, 2022
DOI: 10.1097/JU.0000000000002749
PMID: 35549460


We conducted a randomized, single-blind clinical trial comparing the surgical outcomes of robotic-assisted fluoroscopic-guided (RAF group) and ultrasound-guided (US group) renal access in mini-percutaneous nephrolithotomy (PCNL). We recruited patients who underwent mini-PCNL with ureteroscopic assistance for large renal stones between January 2020 and May 2021. Block randomization was performed using online software. Automated needle target with X-ray was used for fluoroscopic-guided renal access in the RAF group. PCNL was performed by residents using a pneumatic lithotripsy system with 16.5-/17.5-Fr tracts. The primary outcome was single puncture success, and the secondary outcomes were stone-free rate, complication rate, parameters measured during renal access, and fluoroscopy time. In total, 71 patients (US group=35, RAF group=36) were enrolled. No difference was seen in the single puncture success rate between the US and RAF groups (34.3% and 50.0%, p=0.2). In 14.3% cases in the US group versus no cases in the RAF group, the resident was unable to obtain access due to difficult targeting (p=0.025). The mean number of needle punctures was significantly fewer, and the median duration of needle puncture was shorter in the RAF group (1.83 vs. 2.51 times, p=0.025; 5.5 vs. 8.0 minutes, p=0.049, respectively). The stone-free rate at 3 months after surgery was 83.3% and 70.6% in the RAF and US groups, respectively (p=0.26). Multivariate analysis revealed that RAF guidance reduced the mean number of needle punctures by 0.73 times (p=0.021). Robotic-assisted fluoroscopic-guided renal access in mini-PCNL may have further potential applications in this field.

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