Image-guided surgical planning of percutaneous nephrolithotomy with patient-specific CTRs.

PURPOSE: We propose the utilization of patient-specific concentric-tube robots (CTRs) whose designs are optimized to enhance their volumetric reachability of the renal stone, thus reducing the morbidities associated with percutaneous nephrolithotomy procedures. By employing a nested optimization-driven scheme, this work aims to determine a single surgical tract through which the patient-tailored CTR is deployed. We carry out a sensitivity analysis on the combined percutaneous access and optimized CTR design with respect to breathing-induced excursion of the kidneys based on preoperative images. Further, an investigation is also performed of the appropriateness and effectiveness of the percutaneous access provided by the proposed algorithm compared to that of an expert urologist. METHODS: The method is based on an ellipsoidal approximation to the renal calculi and a grid search over candidate skin areas and available renal calyces using an anatomically constrained kinematic mapping of the CTR. Percutaneous access is selected for collision-free CTR deployment to the centroid of the stones with minimal positional error at the renal calyx. Further optimization of the CTR design results in a robot tailored to the therapeutic anatomical features of each clinical case. The study examined 14 sets of clinical data of PCNL patients, analyzing stone reachability using preoperative images and breathing-induced motions of the kidney. An experienced urologist qualitatively assessed the adequacy of percutaneous access generated by the algorithm. RESULTS: An assessment conducted by an expert urologist found that the percutaneous accesses produced by the proposed approach were found to be comparable to those chosen by the expert surgeon in most clinical cases. The simulated results demonstrated a mean volume coverage of [Formula: see text] for static anatomy and [Formula: see text] and [Formula: see text] when considering a 1 cm excursion of the kidney in the craniocaudal directions due to respiration or tool-tissue interaction. CONCLUSION: The optimization-driven scheme for determining a single tract surgical plan, coupled with the use of a patient-specific CTR, shows promising results for improving percutaneous access in PCNL procedures. This approach clearly shows the potential for enhancing the quality and suitability of percutaneous accesses, addressing the challenges posed by staghorn and non-staghorn stones during PCNL procedures. Further research involving clinical validation is necessary to confirm these findings and explore the potential clinical benefits of the approach.

On Surgical Planning of Percutaneous Nephrolithotomy with Patient-Specific CTRs.

Percutaneous nephrolithotomy (PCNL) is considered a first-choice minimally invasive procedure for treating kidney stones larger than 2 cm. It yields higher stone-free rates than other minimally invasive techniques and is employed when extracorporeal shock wave lithotripsy or uteroscopy are, for instance, infeasible. Using this technique, surgeons create a tract through which a scope is inserted for gaining access to the stones. Traditional PCNL tools, however, present limited maneuverability, may require multiple punctures and often lead to excessive torquing of the instruments which can damage the kidney parenchyma and thus increase the risk of hemorrhage. We approach this problem by proposing a nested optimization-driven scheme for determining a single tract surgical plan along which a patient-specific concentric-tube robot (CTR) is deployed so as to enhance manipulability along the most dominant directions of the stone presentations. The approach is illustrated with seven sets of clinical data from patients who underwent PCNL. The simulated results may set the stage for achieving higher stone-free rates through single tract PCNL interventions while decreasing blood loss.

Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision.

The unprecedented shock caused by the COVID-19 pandemic has severely influenced the delivery of regular healthcare services. Most non-urgent medical activities, including elective surgeries, have been paused to mitigate the risk of infection and to dedicate medical resources to managing the pandemic. In this regard, not only surgeries are substantially influenced, but also pre- and post-operative assessment of patients and training for surgical procedures have been significantly impacted due to the pandemic. Many countries are planning a phased reopening, which includes the resumption of some surgical procedures. However, it is not clear how the reopening safe-practice guidelines will impact the quality of healthcare delivery. This perspective article evaluates the use of robotics and AI in 1) robotics-assisted surgery, 2) tele-examination of patients for pre- and post-surgery, and 3) tele-training for surgical procedures. Surgeons interact with a large number of staff and patients on a daily basis. Thus, the risk of infection transmission between them raises concerns. In addition, pre- and post-operative assessment also raises concerns about increasing the risk of disease transmission, in particular, since many patients may have other underlying conditions, which can increase their chances of mortality due to the virus. The pandemic has also limited the time and access that trainee surgeons have for training in the OR and/or in the presence of an expert. In this article, we describe existing challenges and possible solutions and suggest future research directions that may be relevant for robotics and AI in addressing the three tasks mentioned above.