Percutaneous Kidney Puncture with Three-dimensional Mixed-reality Hologram Guidance: From Preoperative Planning to Intraoperative Navigation

Porpiglia, Francesco; Checcucci, Enrico; Peretti, D.; Piramide, Federico; Cillis, Sabrina De; Piana, Alberto; Niculescu, G.; Verri, Paolo; Manfredi, Matteo; Poggio, M.; Stura, Ilaria; Migliaretti, Giuseppe; Cossu, M.; Fiori, Cristian

doi:10.1016/j.eururo.2021.10.023

Cited by 34 publications

(18 citation statements)

References 24 publications

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“…22 Moreover, technological innovation with 3D models has provided us with a cross-reality tool for the simulation and navigation of renal access during PCNL. 23 Virtual reality, 24 augmented reality using an iPadÒ (Apple Inc., Cupertino, California) 25 and mixed-reality hologram, 26 can reduce radiation exposure as well as renal puncture time or number of attempts. Electromagnetic-guided percutaneous access has promising features with direct navigation from the ureteroscope tip, which provides semiautomatic targeting with minimal radiation and a short learning curve.…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Single-Blind Clinical Trial Comparing Robotic-Assisted Fluoroscopic-Guided with Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy

et al. 2022

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Purpose: We conducted a randomized, single-blind clinical trial comparing the surgical outcomes of robotic-assisted fluoroscopic-guided (RAF group) and ultrasound-guided (US group) renal access in mini-percutaneous nephrolithotomy (PCNL). Materials and Methods: We recruited patients who underwent mini-PCNL with ureteroscopic assistance for large renal stones between January 2020 and May 2021. Block randomization was performed using online software. Automated needle target with x-ray was used for fluoroscopic-guided renal access in the RAF group. PCNL was performed by residents using a pneumatic lithotripsy system with 16.5Fr/17.5Fr tracts. The primary outcome was single puncture success, and the secondary outcomes were stone-free rate, complication rate, parameters measured during renal access and fluoroscopy time. Results: In total, 71 patients (35 in US group, 36 in RAF group) were enrolled. No difference was seen in the single puncture success rate between the US and RAF groups (34.3% and 50.0%, p[0.2). In 14.3% cases in the US group vs no cases in the RAF group, the resident was unable to obtain access due to difficult targeting (p[0.025). The mean number of needle punctures was significantly fewer, and the median duration of needle puncture was shorter in the RAF group (1.83 vs 2.51 times, p[0.025; 5.5 vs 8.0 minutes, p[0.049, respectively). The stone-free rate at 3 months after surgery was 83.3% and 70.6% in the RAF and US

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Section: Discussionmentioning

confidence: 99%

A Randomized, Single-Blind Clinical Trial Comparing Robotic-Assisted Fluoroscopic-Guided with Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy

et al. 2022

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“…In this regard, Porpiglia et al ( 39 ) recently developed 3D MR holograms of the kidney anatomy that were overlapped onto the surgical field to establish the access point and guide the needle puncture during 10 endoscopic combined intrarenal surgeries (ECIRS) for kidney stones. A comparative analysis with a retrospective series of patients who underwent the standard procedure showed a significantly shorter radiation exposure time and a higher success rate for kidney puncture at the first attempt for the 3D MR holograms group.…”

Section: Mixed Realitymentioning

confidence: 99%

Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives

et al. 2022

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New technological innovations and cutting-edge techniques have led to important changes in the surgical management of pediatric urolithiasis. Miniaturized technologies and minimally invasive approaches have been increasingly used in children with urinary stones to minimize surgical complications and improve patient outcomes. Moreover, the new computer technologies of the digital era have been opening new horizons for the preoperative planning and surgical treatment of children with urinary calculi. Three-dimensional modeling reconstructions, virtual, augmented, and mixed reality are rapidly approaching the surgical practice, equipping surgeons with powerful instruments to enhance the real-time intraoperative visualization of normal and pathological structures. The broad range of possibilities offered by these technological innovations in the adult population finds increasing applications in pediatrics, offering a more detailed visualization of small anatomical structures. This review illustrates the most promising techniques and devices to enhance the surgical treatment of pediatric urolithiasis in children, aiming to favor an early adoption and to stimulate more research on this topic.

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“…In a cohort study by Porpiglia et al, in which 10 patients underwent MR-guided percutaneous nephrolithotomy, the mean operative duration was significantly higher in MR-guided surgeries (median 108 vs. 91 min, p = 0.02), while the rates of complications were similar between cohorts (30% vs. 40%), and inpatient stay durations were the same (median 4). 88…”

Section: Percutaneous Surgerymentioning

confidence: 99%

“…As well as showing pre-planned screw paths, the system used by While these data are positive, there are some suggestions that the intraoperative use of AR and MR might not improve navigational speed and operative duration. Firstly, two studies reported significantly increased operating times using AR and MR. 22,88 It is unclear whether this reflects techniques which are inherently slower, or reflects surgeons using newer, less practised techniques, or both. Notably, many studies commented on surgeons going through learning curves during their uses of AR and MR, and two studies evidenced that operations became faster with experience.…”

Section: Similarly Gu Et Al Clearly Demonstrated How Mr In Pedicle Screwmentioning

confidence: 99%

The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: A systematic review

Bollen

Awad

Langridge

et al. 2022

Robotics Computer Surgery

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Background This systematic review aims to critically appraise the intraoperative use of augmented and mixed reality technology to improve surgical outcomes. Method A literature search of PubMed, Scopus, Cochrane Central Register of Controlled Trials, http://ClinicalTrials.gov and WHO ICTRP was performed in accordance with Cochrane Handbook for Systematic Reviews of Interventions. Results This review included 94 studies on 2473 patients, comprising 78 studies on augmented reality and 16 on mixed reality. This technology has seen broad intraoperative application. Augmented and mixed reality can reduce operative duration, blood loss, and the duration of inpatient care. Current evidence shows that they achieve this most in percutaneous surgery. Conclusions Augmented and mixed reality technology improve surgical outcomes by increasing navigational speed and reducing navigational error intraoperatively. However, they have technical limitations which are the subject of ongoing research. Further studies are necessary to define how this technology is best applied intraoperatively. Systematic Review Registration: PROSPERO CRD42020205892.

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Percutaneous Kidney Puncture with Three-dimensional Mixed-reality Hologram Guidance: From Preoperative Planning to Intraoperative Navigation

Cited by 34 publications

References 24 publications

A Randomized, Single-Blind Clinical Trial Comparing Robotic-Assisted Fluoroscopic-Guided with Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy

A Randomized, Single-Blind Clinical Trial Comparing Robotic-Assisted Fluoroscopic-Guided with Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy

Pediatric Urolithiasis: Current Surgical Strategies and Future Perspectives

The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: A systematic review

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