Aid to percutaneous renal access by virtual projection of the ultrasound puncture tract onto fluoroscopic images

The use of robots (particularly in urology) or navigation systems (particularly in orthopedics) becomes increasingly frequent. Considering the complexity of such systems, their invention by the surgeon becomes impossible and cooperation between researchers and surgeons is necessary for their development. The objective of this article is to describe advances in the creation of a system helping the surgeon to perform the puncture of the kidney during the percutaneous surgery of this organ, usually for the ablation of a lithiasis. We believe that it is possible to improve the precision and safety of percutaneous renal access by using computerized methods to virtually project the ultrasound puncture tract onto pre-operative fluoroscopic images. Clinical problems are presented which led to the development of such a tool with the help of a research laboratory. We describe successively the technologies employed, the various stages of research, the first studies on phantom and the first tests on patients. Finally the question of the technology transfer is discussed through labeling CE-approval of the system allowing its use in a routine way in the operating room.