ABSTRACT
Introduction: Gaining access to the kidney is crucial step in percutaneous nephrolithotomy (PCNL); it has a steep learning curve. Objective: Describe the mathematical method to predict renal puncture angle and distance based on preoperative computed tomography (CT) measurements. Then evaluating how it correlates with measured values. Patients and Methods: The study was prospectively designed. After ethical committee approval, the study uses data from preoperative CT to construct a triangle so we can estimate puncture depth and angle. A triangle of three points, the first is point of entry to the pelvicalyceal system (PCS), the second is point on the skin perpendicular to it, and the third where the needle punctures the skin. The needle travel is estimated using the Pythagorean theorem and puncture angle using the inverse sine function. We evaluated 40 punctures in 36 PCNL procedures. After PCS puncture using fluoroscopy-guided triangulation, we measured the needle travel distance and angle to the horizontal plane. Then compared the results with mathematically estimated values. Results: We targeted posterior lower calyx in 21 (70%) case. The correlation between measured and estimated needle travel distance with Rho coefficient of 0.76 with P < 0.001. The mean difference between the estimated and the measured needle travel was - 0.37 ± 1.2 cm (-2.6-1.6). Measured and estimated angle correlate with Rho coefficient of 0.77 and P < 0.001. The mean difference between the estimated and the measured angle was 2° ± 8° (-21°-16°). Conclusion: Mathematical estimation of needle depth and angle for gaining access to the kidney correlates well with measured values.
ABSTRACT
Limited data exist regarding knowledge and perceptions of surgeons and patients about robotic-assisted surgery (RAS) in the Middle East. This study aimed to explore perceptions of surgeons and patients about RAS. A questionnaire-based survey was distributed among surgeons of different specialties and patients. Between March and September 2019, 278 and 256 surveys were completed by surgeons and patients, respectively (95.2% and 94.8% response rate, respectively). The surgeons' self-reported experience with technology was related to the level of comfort with computers and computer literacy. Most surgeons have heard of RAS availability, and the majority agreed to its introduction into the healthcare system. However, only 75 (27%) of the surgeons thought that the surgeon has complete control over the robot, and 69 (25%) surgeons were not sure of the level of control the surgeon has over the robot reflecting poor knowledge about this technology. Less than a third of patient respondents have heard of RAS. However, half of them would consider it should they need to undergo surgery. When compared to open surgery, 23 (9%), 26 (10%), and 94 (37%) patient respondents thought that RAS caused less pain, had fewer complications, and was faster than conventional surgery, respectively. Knowledge and perceptions about RAS are limited among surgeons and patients in Kuwait. Efforts should focus on increasing awareness.
