Application of a three‐dimensional visualization model in intraoperative guidance of percutaneous nephrolithotomy

Abstract

Objectives: To establish a three-dimensional visualization model of percutaneous nephrolithotomy, apply it to guiding intraoperative puncture in a mixed reality environment, and evaluate its accuracy and clinical value. Methods: Patients with percutaneous nephrolithotomy indications were prospectively divided into three-dimensional group and control group with a ratio of 1:2. For patients in three-dimensional group, positioning markers were pasted on the skin and enhanced computed tomography scanning was performed in the prone position. Holographic three-dimensional models were made and puncture routes were planned before operation. During the operation, the three-dimensional model was displayed through HoloLens glass and visually registered with the patient's body. Puncture of the target renal calyx was performed under three-dimensional-image guiding and ultrasonic monitoring. Patients in the control group underwent routine percutaneous nephrolithotomy in the prone position under the monitoring of B-ultrasound. Deviation distance of the kidney, puncture time, puncture attempts, channel coincidence rate, stone clearance rate, and postoperative complications were assessed.Results: Twenty-one and 40 patients were enrolled in three-dimensional and control group, respectively. For three-dimensional group, the average deviation between virtual and real kidney was 3.1 AE 2.9 mm. All punctures were performed according to preoperative planning. Compared with the control group, the three-dimensional group had shorter puncture time (8.9 AE 3.3 vs 14.5 AE 6.1 min, P < 0.001), fewer puncture attempts (1.4 AE 0.6 vs 2.2 AE 1.5, P = 0.009), and might also have a better performance in stone clearance rate (90.5% vs 72.5%, P = 0.19) and postoperative complications (P = 0.074). Conclusions: The percutaneous nephrolithotomy three-dimensional model manifested acceptable accuracy and good value for guiding puncture in a mixed reality environment.

Navigation systems and 3D imaging in percutaneous nephrolithotripsy: improving outcomes and safety

“…In another prospective case-control study, 61 patients scheduled for PCNL were assigned 1 : 2 into a 3D and control group, respectively [23 ▪ ]. Puncture routes were planned preoperatively based on holographic 3D models created using enhanced CT scan images in a prone position after pasting positioning skin markers.…”

Microsoft HoloLens 2 in Medical and Healthcare Context: State of the Art and Future Prospects

“…Most of the studies [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ] in this review are focused on application of HoloLens 2 in surgical navigation in the operating room and in the emergency department. The use of the AR/MR based system in this context provided the user with computer-generated information superimposed to real-world environment and improved accuracy, safety and efficacy of surgical procedures [ 86 ].…”

Advances in percutaneous renal puncture: a comprehensive review of the literature

“…The experimental group displayed diminished puncture time (8.9 vs. 14.5 min, P < 0.001) and the number of puncture attempts (1 vs. 2, P ¼ 0.025) to a significant degree. It is noticeable that this tool facilitated routine percutaneous renal punctures performed by the residents and complex punctures carried out by experienced surgeons [37]. Porpiglia et al [38] compared the 3D hologram puncture with the combined ultrasound-fluoroscopy puncture including 10 patients in each group.…”