Kidney targeting and puncturing during percutaneous nephrolithotomy: recent advances and future perspectives

Background and Purpose: Precise needle puncture of the kidney is a challenging and essential step for successful percutaneous nephrolithotomy (PCNL). Many devices and surgical techniques have been developed to easily achieve suitable renal access. This article presents a critical review to address the methodologies and techniques for conducting kidney targeting and the puncture step during PCNL. Based on this study, research paths are also provided for PCNL procedure improvement. Methods: Most relevant works concerning PCNL puncture were identified by a search of Medline/PubMed, ISI Web of Science, and Scopus databases from 2007 to December 2012. Two authors independently reviewed the studies. Results: A total of 911 abstracts and 346 full-text articles were assessed and discussed; 52 were included in this review as a summary of the main contributions to kidney targeting and puncturing. Conclusions: Multiple paths and technologic advances have been proposed in the field of urology and minimally invasive surgery to improve PCNL puncture. The most relevant contributions, however, have been provided by the applicationofmedical imaging guidance, newsurgical tools,motion tracking systems, robotics, andimage processing and computer graphics. Despite the multiple research paths for PCNL puncture guidance, no widely acceptable solution has yet been reached, and it remains an active and challenging research field. Future developments should focus on real-time methods, robust and accurate algorithms, and radiation free imaging techniques

A Morte Saiu À Rua…

Diz a Lei 53/03, com última versão da Lei 60/15: “1 ‐ Quem praticar os factos previstos no n.º 1 do artigo 2.º, com a intenção nele referida, é punido com pena de prisão de 2 a 10 anos, ou com a pena correspondente ao crime praticado, agravada de um terço nos seus limites mínimo e máximo, se for igual ou superior àquela, não podendo a pena aplicada exceder o limite referido no n.º 2 do artigo 41.º do Código Penal”. § Says the Law 53/03, with the latest version of Law 60/15: "1 - Whoever commits the acts referred to in paragraph 1 of article 2, with the intention that it shall be punished with imprisonment from 2 to 10 years, or the penalty corresponding to the crime committed, increased by one third in its minimum and maximum limits, if it is equal or superior to, the penalty may not exceed the limit referred to in paragraph 2 of Article 41 of Penal code ".