Automated Needle Targeting with X-ray (ANT-X)-Robot-assisted device for percutaneous nephrolithotomy (PCNL) with its first successful use in human

Introduction: To make percutaneous access easier in PCNL, we developed Automated Needle Targeting with X-ray (ANT-X). Method: ANT-X uses an image registration software with a closed loop feedback system to autoalign the puncture needle to the desired calyx using the bullseye technique. We tried percutaneous punctures on a live pig model and compared the results with free-hand technique. We then performed our first PCNL in a human subject with the aid of ANT-X. Our patient was a 48 year-old gentleman with a 1.4cm left lower pole stone. Results: Initial results for live animal trial showed radiation exposure for robot-assisted arm during puncture was reduced by 26% compared to the free-hand technique (8.2mGy vs 11.2mGy). In the human trial, obtaining percutaneous access was successful at first attempt. Conclusion: ANT-X system can help surgeons feel confident and potentially reduce complications, hence enabling more surgeons to adopt this procedure.