Percutaneous nephrolithotomy (PNL) is an endoscopic technique used for treating large stones, multiple stones, and staghorn calculi. Although minimally invasive, complication rate of PNL reaches 25%, and it is partially associated with needle puncture during nephrostomy tract preparation. Continuous improvement of armamentarium and imaging methods and the introduction of three-dimensional (3D) visualizations optimize the procedure; however, the rapid and precise establishment of the nephrostomy tract is still difficult. In the present short communication, we present the PNL procedure assisted by a personalized 3D-printed surgical guide (SG) to ensure fast and precise needle access to the renal collecting system. We also describe the workflow for SG preparation, which consists of CT image acquisition and data segmentation, planning a safe needle insertion path, SG designing, and guide manufacturing. With the growing market of low-cost 3D printers, the presented technique can shorten the PNL procedure time and decrease the complication rate associated with needle puncture in a cost-efficient manner.

Keywords:
Percutaneous nephrolithotomy, Three-dimensional printers, Procedure time, Complications, Surgical guide
1.
Wickham JE, Kellett MJ: Percutaneous nephrolithotomy. Br J Urol 1981;53:297-299.
2.
Oner S, Okumus MM, Demirbas M, Onen E, Aydos MM, Ustun MH, Kilic M, Avci S: Factors influencing complications of percutaneous nephrolithotomy: a single-center study. Urol J 2015;12:2317-2323.
3.
Li H, Chen Y, Liu C, Li B, Xu K, Bao S: Construction of a three-dimensional model of renal stones: comprehensive planning for percutaneous nephrolithotomy and assistance in surgery. World J Urol 2013;31:1587-1592.
4.
Federick DR, Del Rey M: A surgical guide for insertion of implant fixtures. Implant Dent 1992;1:129-131.
5.
Van de Wiele G, Teughels W, Vercruyssen M, Coucke W, Temmerman A, Quirynen M: The accuracy of guided surgery via mucosa-supported stereolithographic surgical templates in the hands of surgeons with little experience. Clin Oral Implants Res 2015;26:1489-1494.
6.
Gadzhiev N, Brovkin S, Grigoryev V, Tagirov N, Korol V, Petrov S: Sculpturing in urology, or how to make percutaneous nephrolithotomy easier. J Endourol 2015;29:512-517.
7.
Thiruchelvam N, Mostafid H, Ubhayakar G: Planning percutaneous nephrolithotomy using multidetector computed tomography urography, multiplanar reconstruction and three-dimensional reformatting. BJU Int 2005;95:1280-1284.
8.
Chen TT, Wang C, Ferrandino MN, Scales CD, Yoshizumi TT, Preminger GM, Lipkin ME: Radiation exposure during the evaluation and management of nephrolithiasis. J Urol 2015;194:878-885.
9.
Wu W, Zhao Z, Zhu H, Yang D, Ou L, Liang Y, Zhao Z, Zeng G: Safety and efficacy of minimally invasive percutaneous nephrolithotomy in treatment of calculi in horseshoe kidneys. J Endourol 2014;28:926-929.
10.
Rassweiler J, Rassweiler MC, Klein J: New technology in ureteroscopy and percutaneous nephrolithotomy. Curr Opin Urol 2016;26:95-106.
© 2016 S. Karger AG, Basel
2016
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