PURPOSE To evaluate the efficacy of supine percutaneous renal access by robot-assisted (RA) fluoroscopy and ultrasound (US) guidance in terms of procedural outcomes and surgeon workload. METHODS We conducted a multicenter, randomized, controlled benchtop study involving 32 urologists using a renal phantom model. RA puncture was performed using the developed version of automated needle targeting with X-ray (ANT-X), which determines the direction of the needle. US puncture was performed under US guidance. The primary endpoint was the single-puncture success rate, and the secondary outcomes were the procedural time for each step, time of fluoroscopic exposure, and workload assessment. RESULTS The single-puncture success rates were 90.6% and 56.3% for RA and US punctures, respectively (P<0.01). In RA puncture, the median device setup time was 120 s longer, the median total procedural time was 100 s longer, the median time of fluoroscopic exposure was 40 s longer, the median needle puncture time was 17 s shorter, and the distance from the target sphere was 1 cm shorter than those in US puncture (all P<0.01). The mental and physical task workload, effort required by the surgeons, frustration felt by the surgeons, and overall National Aeronautics and Space Administration Task Load Index scores were lower in the RA puncture group than in the US puncture group (P=0.01, P=0.046, P<0.01, P=0.021, and P=<0.01, respectively). CONCLUSIONS RA puncture using ANT-X, which can also be used for puncture in the supine position, offers advantages over renal puncture in terms of accuracy and surgical workload.

中文翻译：

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使用双平面方法的机器人辅助透视引导和超声引导之间经皮肾通路的比较：一项多中心随机对照台式研究。

目的 评估机器人辅助 (RA) 透视和超声 (US) 引导下仰卧位经皮肾通路在手术结果和外科医生工作量方面的效果。方法 我们使用肾模型模型进行了一项多中心、随机、对照台式研究，涉及 32 名泌尿科医生。RA 穿刺是使用 X 射线自动针瞄准 (ANT-X) 的开发版本进行的，它确定针的方向。超声穿刺是在超声引导下进行的。主要终点是单次穿刺成功率，次要终点是每个步骤的手术时间、透视曝光时间和工作量评估。结果 RA和US穿刺单次穿刺成功率分别为90.6%和56.3%（P<0.01）。在 RA 穿刺中，中位装置设置时间延长 120 秒，中位总手术时间延长 100 秒，中位透视曝光时间延长 40 秒，中位穿刺针时间缩短 17 秒，并且距穿刺点的距离目标球比超声穿刺短1 cm（均P<0.01）。RA穿刺组的精神和身体任务负荷、外科医生所需的努力、外科医生感受到的挫败感以及美国国家航空航天局任务负荷指数总体评分均低于US穿刺组（P=0.01，P= 0.046、P<0.01、P=0.021 和 P=<0.01）。结论 使用 ANT-X 进行 RA 穿刺，也可用于仰卧位穿刺，在准确性和手术工作量方面优于肾穿刺。