A review of emerging technologies and techniques for percutaneous nephrolithotomy access.

PURPOSE OF REVIEW: The limited adoption of percutaneous nephrolithotomy (PCNL) among urologists can be explained by the steep learning curve and limited structured training in several residency programs. This review provides a summary of emerging technologies and techniques designed to assist with percutaneous renal access, focusing on their clinical applicability and available outcome data.

RECENT FINDINGS: A literature review was conducted in January 2025, searching for studies describing emerging renal access technologies and techniques. Recent guidance developments include electromagnetic systems, retrograde and direct visualization, fusion of different image modalities with ultrasound, robot-assisted needle positioning and navigation, robot-assisted ultrasound needle guidance, and laser alignment radiation reduction technique. Available data suggest ongoing efforts focused on improved puncture accuracy, ease of technology adoption, and reduction in radiation exposure.

SUMMARY: The number of emerging technologies to assist with percutaneous renal access has significantly increased during the last decade. While the cost-effectiveness of most innovations is yet to be elucidated, they may help democratize renal access and lower technical barriers, potentially facilitating broader adoption of this technique, particularly in lower-volume or less experienced centers.