Robotic-assisted versus manual Uro Dyna-CT-guided puncture in an ex-vivo kidney phantom

Introduction and objectives: Challenging percutaneous renal punctures to gain access to the kidney requiring guidance by cross-sectional imaging. To test the feasibility of robotic-assisted CT-guided punctures (RP) and compare them with manual laser-guided punctures (MP) with Uro Dyna-CT (Siemens Healthcare Solutions, Erlangen, Germany).Material and methods: The silicon kidney phantom contained target lesions of three sizes. RP were performed using a robotic assistance system (guidoo, BEC GmbH, Pfullingen, Germany) with a robotic arm (LBR med R800, KUKA AG, Augsburg, Germany) and a navigation software with a cone-beam-CT Artis zeego (Siemens Healthcare GmbH, Erlangen, Germany). MP were performed using the syngo iGuide Uro-Dyna Artis Zee Ceiling CT (Siemens Healthcare Solutions). Three urologists with varying experience performed 20 punctures each. Success rate, puncture accuracy, puncture planning time (PPT), and needle placement time (NPT) were measured and compared with ANOVA and Chi-Square Test.Results: One hundred eighteen punctures with a success rate of 100% for RP and 78% for MP were included. Puncture accuracy was significantly higher for RP. PPT (RP: 238 +/- 90s, MP: 104 +/- 21s) and NPT (RP: 128 +/- 40s, MP: 81 +/- 18s) were significantly longer for RP. The outcome variables did not differ significantly with regard to levels of investigators' experience.Conclusion: The accuracy of RP was superior to that of MP. This study paves the way for first in-human application of this robotic puncture system.