Automated Needle Targeting with X-ray (ANT-X)

2022: Start using the robot

As it became known in June 2022, doctors began to use a robot that removes kidney stones. We are talking about a device with artificial intelligence called Automated Needle Targeting with X-ray (ANT-X), developed by the Singapore company NDR Medical Technology.

The results of a study of the effectiveness of a robotic system for percutaneous nephrolitotomy (CNL) and renal access were published. CNL is an effective, minimally invasive procedure that is used to remove large kidney stones. For surgery, you need to create access from the skin on the back to the kidney, this is an important but difficult step in the PNL procedure. If access to the kidney is done incorrectly, it can lead to serious complications, such as bleeding, damage to the chest and intestines, or even sepsis.

Doctors start using robot that removes kidney stones

This is the first human study to compare RAF and conventional ultrasound guidance for renal access during CNL, and the first clinical application of ANT-X, Taguchi says.

The study was conducted at NCU Hospital with 71 patients - 36 in the RAF group and 35 in the US group. The primary outcome of the study was the success of a single puncture, and the secondary outcomes were the frequency of stone-free puncture (SFR), the rate of complications, and the parameters measured during renal access and the time of fluoroscopy.

The rate of successful single punctures was ~ 34 and 50% in the US and RAF groups, respectively. The mean number of punctures was significantly less in the RAF group (1.82 times) compared to the US group (2.51 times). In 14.3% of cases with US guidance, the resident was unable to provide renal access due to procedural difficulties and a surgeon change was required. However, in the RAF group, such a problem did not arise in any case. The average duration of needle puncture was also significantly shorter in the RAF group (5.5 minutes versus 8.0 minutes). There were no significant differences in other secondary measures. These results showed that the use of RAF guidance reduced the average number of needle punctures by 0.73 times.

Multiple renal accesses during CNL are directly associated with postoperative complications, including decreased renal function. Therefore, the low incidence of needle punctures and the shorter duration of punctures demonstrated by ANT-X may provide a better long-term outcome for patients. While the actual PNL was performed by residents in both the RAF and US groups, the renal access was created by one novice surgeon in the RAF group using ANT-X. This demonstrates the safety and convenience of a new robotic device that can reduce the training burden on surgeons and allow more hospitals to offer PNL procedures.

Taguchi, describing the potential benefits of the RAF device, says: ANT-X simplifies a complex procedure like PCNL, which allows more doctors to carry it out and help more patients in the process. As a robotic technology with artificial intelligence, the technique could pave the way for the automation of similar interventional surgeries, which could reduce procedure time, ease the burden of senior physicians, and possibly reduce the occurrence of complications.[1]

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