Author(s):
Rodrigues, Pedro L. 
; F. Rodrigues, Nuno ; Fonseca, Jaime ; Lima, Estevão ; Vilaça, João L.
Date: 2013
Persistent ID: http://hdl.handle.net/11110/515
Origin: CiencIPCA
Subject(s): Percutaneous Nephrolithotomy; Kidney Targeting; Puncturing
Description
Background and Purpose: Precise needle puncture of the kidney is a challenging and essential step for successful
percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily
achieve suitable renal access. This article presents a critical review to address the methodologies and techniques
for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also
provided for PCNL procedure improvement.
Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI
Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the
studies.
Results: A total of 911 abstracts and 346 full-text articles were assessed and discussed; 52 were included in this
review as a summary of the main contributions to kidney targeting and puncturing.
Conclusions: Multiple paths and technologic advances have been proposed in the field of urology and minimally
invasive surgery to improve PCNL puncture. The most relevant contributions, however, have been provided by the
applicationofmedical imaging guidance, newsurgical tools,motion tracking systems, robotics, andimage processing
and computer graphics. Despite the multiple research paths for PCNL puncture guidance, no widely acceptable
solution has yet been reached, and it remains an active and challenging research field. Future developments should
focus on real-time methods, robust and accurate algorithms, and radiation free imaging techniques
