This dissertation of Riemer Kingma investigated the use of cone beam computed tomography (CBCT) in a hybrid operating room to detect residual stones during percutaneous nephrolithotomy (PCNL), in order to increase stone-free rates. Additionally, the dissertation elucidates the impact of residual stones on stone-related morbidity.
A retrospective analysis demonstrated that both small and larger residual stones following stone treatment increase the risk of stone-related events, challenging the previous assumption that small residual fragments (≤4 mm in diameter) are clinically insignificant. This finding underscores the importance of achieving complete stone clearance during PCNL. To enhance intraoperative detection of residual stones, the effectiveness of CBCT was evaluated. An exploratory study revealed that CBCT successfully detects additional residual stones, enabling their removal during the procedure, which could improve stone-free rates.
In a randomized study, the CAPTURE trial, CBCT was shown to significantly contribute to higher stone-free rates after a single procedure without a significant increase in complications. A retrospective analysis further indicated that the added value of CBCT seems to be more apparent in complex stone cases. Optimization of CBCT protocols demonstrated that lower radiation doses are feasible without compromising image quality, thereby enhancing the safety of this technique.
The findings suggest that intraoperative CBCT can be a valuable addition to PCNL, with potential to reduce re-interventions and healthcare costs in the long term. Further studies are needed to assess the long-term outcomes and cost-effectiveness of CBCT-assisted procedures. This dissertation contributes to the optimization of kidney stone treatments worldwide.
