Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

“Enriquecimento Injustificado”: simples ignorância ou disparatada incompetência?

Pelos fundamentos expostos no Acórdão nº 377/2015, de 27/7, o T.C. decidiu pronunciar-se pela inconstitucionalidade das normas constantes do n.º 1 do artigo 1º e do artigo 2º do Decreto da Assembleia da República nº 369/XII, por violação dos artigos 18º/2 (necessidade, adequação, proporcionalidade e intervenção mínima do Direito Criminal/Penal), 29º/1 (Princípio da Legalidade Criminal) e 32º/2 (Presunção da Inocência) da Constituição. Imagine-se que depois de se ser condenado pela Comunicação Social, ainda temos que provar a nossa inocência! § On those grounds in Judgment No 377/2015 of 27/7, the Constitutional Court decided to rule the unconstitutionality of the rules in paragraph 1 of Article 1 and Article 2 of Decree of the National Assembly No. 369 / XII, for violation of articles 18/2 (necessity, appropriateness, proportionality and minimum intervention of Criminal Law / Criminal), 29/1 (Principle of Criminal Legality) and 32/2 (Presumption of Innocence) of the Constitution. Imagine that after being convicted by the Social Communication, we still have to prove our innocence!