Akand Murat, Civcik Levent, Buyukaslan Ahmet, Altintas Emre, Kocer Erdinc, Koplay Mustafa, Erdogru Tibet
School of Medicine, Department of Urology, Selcuk University, Konya, Turkey.
Selçuk Üniversitesi, Alaeddin Keykubat Kampüsü, Tıp Fakültesi Hastanesi, E-Blok, Kat:1, Üroloji Polikliniği, Selçuklu, 42075, Konya, Turkey.
Int Urol Nephrol. 2019 Jan;51(1):17-25. doi: 10.1007/s11255-018-2037-0. Epub 2018 Nov 24.
We describe a novel technique that uses mathematical calculation software, 3-dimensional (3D) modeling and augmented reality (AR) technology for access during percutaneous nephrolithotomy (PCNL) and report our first preliminary results in two different ex-vivo models.
Novel software was created in order to calculate access point and angle by using pre-operative computed tomography (CT) obtained in 50 patients. Two scans, 27 s and 10 min after injection of contrast agent, were taken in prone PCNL position. By using DICOM objects, mathematical and software functions were developed to measure distance of stone from reference electrodes. Vectoral 3D modeling was performed to calculate the access point, direction angle and access angle. With specific programs and AR, 3D modeling was placed virtually onto real object, and the calculated access point and an access needle according to the calculated direction angle and access angle were displayed virtually on the object on the screen of tablet.
The system was tested on two different models-a stone placed in a gel cushion, and a stone inserted in a bovine kidney that was placed in a chicken-for twice, and correct access point and angle were achieved at every time. Accuracy of insertion of needle was checked by feeling crepitation on stone surface and observing tip of needle touching stone in a control CT scan.
This novel device, which uses software-based mathematical calculation, 3D modeling and AR, seems to ensure a correct access point and angle for PCNL. Further research is required to test its accuracy and safety in humans.
我们描述了一种新颖的技术，该技术使用数学计算软件、三维（3D）建模和增强现实（AR）技术辅助经皮肾镜取石术（PCNL）的穿刺入路，并报告我们在两种不同离体模型中的初步结果。
开发了一种新型软件，通过使用50例患者术前获得的计算机断层扫描（CT）来计算穿刺点和角度。在俯卧位PCNL时，分别在注射造影剂后27秒和10分钟进行两次扫描。利用DICOM对象，开发数学和软件功能来测量结石与参考电极的距离。进行矢量3D建模以计算穿刺点、方向角和穿刺角度。通过特定程序和AR，将3D模型虚拟放置到真实物体上，并在平板电脑屏幕上的物体上虚拟显示计算出的穿刺点以及根据计算出的方向角和穿刺角度确定的穿刺针。
该系统在两种不同模型上进行了测试——一种是将结石置于凝胶垫中，另一种是将结石插入置于鸡体内的牛肾中——测试了两次，每次都获得了正确 的穿刺点和角度。通过感受结石表面摩擦音以及在对照CT扫描中观察针尖端接触结石来检查针插入的准确性。
这种使用基于软件的数学计算、3D建模和AR的新型设备似乎能确保PCNL的穿刺点和角度正确。需要进一步研究以测试其在人体中的准确性和安全性。
