{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:04:49Z","timestamp":1784534689949,"version":"3.55.0"},"reference-count":14,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Percutaneous nephrolithotomy (PCNL) requires precise renal access, a feat that is often challenging and time-consuming. In this light, we evaluated the bubble needle, a standard nephrostomy needle with an integrated two-dimensional bubble level designed to maintain anterior\u2013posterior alignment after a single fluoroscopic image. We hypothesized that the bubble needle would streamline access while providing accuracy comparable to conventional fluoroscopic techniques and substantially reduced radiation exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twenty-one participants (students = 9, residents = 5, attendings = 7) each performed, in random sequence, three punctures using traditional bull\u2019s-eye, rotated bull\u2019s-eye, and bubble needle techniques in a ballistic gel PCNL phantom with a radiopaque target at 10 cm depth. Outcomes were fluoroscopy dose milligray (mGy), fluoroscopy time (s), procedure time (s), and accuracy (mm). Data were analyzed with analysis of variance and mixed-effects models, adjusting for experience and trial number.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 189 punctures were completed. Bubble needle achieved the lowest radiation dose and exposure time (0.23 \u00b1 0.19 mGy; 6.90 \u00b1 5.40 seconds), representing 74%\/70% reductions\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      traditional and 57%\/54%\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      rotated (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Mean procedure time (s) was significantly lower for bubble needle compared to the traditional technique (31.40 \u00b1 13.71 s\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      40.46 \u00b1 22.67 s;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.008) and for rotated compared to traditional technique (25.22 \u00b1 12.34 s\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      40.46 \u00b1 22.67 s;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Mean accuracy (mm) was not significantly different among traditional, rotated, and bubble needle techniques (2.3 \u00b1 3.4 mm\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      1.2 \u00b1 2.7 mm\n                      <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                      1.5 \u00b1 1.5 mm;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.077). Results were consistent across experience levels, with no significant learning effect across trials.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The bubble needle maintains accuracy comparable to conventional fluoroscopic techniques while decreasing procedure time and reducing radiation exposure by more than half.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08927790261451032","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T09:17:34Z","timestamp":1779787054000},"page":"851-858","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Analysis of A Novel Air-Bubble Guided Percutaneous Access Technique Against Traditional Fluoroscopic Techniques"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0290-4316","authenticated-orcid":false,"given":"Bruce M.","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harel C.","family":"Sims","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kriselle","family":"Madamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedamirvala","family":"Saadat","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Badin-Castro","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aymon","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"O\u2019Leary","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Daneshvar","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cwikla","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan M.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Landman","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph V.","family":"Clayman","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengbo","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, Irvine, Orange, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2016.05.090"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2016.05.091"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajur.2021.05.007"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2223-4683.2012.12.01"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.4111\/icu.20220395"},{"key":"e_1_3_3_7_2","unstructured":"Hudson C Schwartz B. 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