Percutaneous Kidney Puncture Using a Novel Contrast-enhanced Ultrasound-guided Technique: First Swine Model

Background and objective: This study introduces a novel dual contrast-enhanced ultrasound (D-CEUS) technique and evaluates its feasibility and safety for an Methods: Percutaneous punctures were performed in six swine, with each animal receiving six bilateral renal punctures (upper, middle, and lower calyces). D-CEUS guidance was used for the left kidney, and conventional ultrasound was used for the right kidney. The outcomes included the first-attempt success rate, preparation time, puncture time, correct puncture rate, and vascular injury incidence. Key findings and limitations: D-CEUS demonstrated statistically significant improvements compared with conventional ultrasound, including a higher first-attempt success rate (94.4% vs 61.1%) and correct puncture rate (100% vs 66.7%), lower vascular injury (0% vs 27.8%), and shorter puncture time (median 26 vs 45 s). However, as this is a preclinical animal study, limitations remain, and clinical validation is needed. All punctures were performed under general anesthesia, followed by tract dilation to 24F along an inserted guidewire. Conclusions and clinical implications: D-CEUS provides real-time visualization of vascular anatomy and needle trajectory in a nondilated collecting system, enhancing puncture accuracy. Its ability to deliver contrast directly through the puncture needle enables precise stone localization and supports the procedure's potential to improve the safety and efficiency of percutaneous nephrolithotomy. Patient summary: In this report, we applied a novel contrast-enhanced ultrasound-guided technique to achieve more precise renal puncture targeting. We found that the application of the novel technique performs better than conventional ultrasound guidance in percutaneous nephrolithotomy.