title: Measurement of bio-impedance with a smart needle to confirm percutaneous kidney access.
abstract: OBJECTIVE
  The traditional method of percutaneous renal access requires freehand needle placement guided by C-arm fluoroscopy, ultrasonography, or computerized tomography. This approach provides limited objective means for verifying successful access. We developed an impedance based percutaneous Smart Needle system and successfully used it to confirm collecting system access in ex vivo porcine kidneys.
  
  
  METHODS
  The Smart Needle consists of a modified 18 gauge percutaneous access needle with the inner stylet electrically insulated from the outer sheath. Impedance is measured between the exposed stylet tip and sheath using Model 4275 LCR meter (Hewlett-Packard, Sunnyvale, California). An ex vivo porcine kidney was distended by continuous gravity infusion of 100 cm. water saline from a catheter passed through the parenchyma into the collecting system. The Smart Needle was gradually inserted into the kidney to measure depth precisely using a robotic needle placement system, while impedance was measured continuously.
  
  
  RESULTS
  The Smart Needle was inserted 4 times in each of 4 kidneys. When the needle penetrated the distended collecting system in 11 of 16 attempts, a characteristic sharp drop in resistivity was noted from 1.9 to 1.1 ohm m. Entry into the collecting system was confirmed by removing the stylet and observing fluid flow from the sheath. This characteristic impedance change was observed only at successful entry into the collecting system.
  
  
  CONCLUSIONS
  A characteristic sharp drop in impedance signifies successful entry into the collecting system. The Smart Needle system may prove useful for percutaneous kidney access.
authors.affiliation: James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Hernandez
authors.forename: V A
authors.initials: VA
authors.lastname: Sinkov
authors.forename: W W
authors.initials: WW
authors.lastname: Roberts
authors.forename: M E
authors.initials: ME
authors.lastname: Allaf
authors.forename: A
authors.initials: A
authors.lastname: Patriciu
authors.forename: T W
authors.initials: TW
authors.lastname: Jarrett
authors.forename: L R
authors.initials: LR
authors.lastname: Kavoussi
authors.forename: D
authors.initials: D
authors.lastname: Stoianovici
mesh_terms: D000818:Animals; D017097:Electric Impedance; D004867:Equipment Design; D009339:Needles; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation*; D013552:Swine