Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
Division of Urology, Department Of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy; Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Uro-technology and Social Media Working Group of the Young Academic Urologists of the European Association of Urology, Arnhem, The Netherlands.
Eur Urol. 2022 Jun;81(6):588-597. doi: 10.1016/j.eururo.2021.10.023. Epub 2021 Nov 17.
Despite technical and technological innovations, percutaneous puncture still represents the most challenging step when performing percutaneous nephrolithotomy. This maneuver is characterized by the steepest learning curve and a risk of injuring surrounding organs and kidney damage.
To evaluate the feasibility of three-dimensional mixed reality (3D MR) holograms in establishing the access point and guiding the needle during percutaneous kidney puncture.
DESIGN, SETTING, AND PARTICIPANTS: This prospective study included ten patients who underwent 3D MR endoscopic combined intrarenal surgery (ECIRS) for kidney stones from July 2019 to January 2020. A retrospective series of patients who underwent a standard procedure were selected for matched pair analysis.
For patients who underwent 3D MR ECIRS, holograms were overlapped on the real anatomy to guide the surgeon during percutaneous puncture. In the standard group, the procedures were only guided by ultrasound and fluoroscopy.
Differences in preoperative and postoperative patient characteristics between the groups were tested using a χ test and a Kruskal-Wallis test for categorical and continuous variables, respectively. Results are reported as the median and interquartile range for continuous variables and as the frequency and percentage for categorical variables.
Ten patients underwent 3D MR ECIRS. In all cases, the inferior calyx was punctured correctly, as planned using the overlapping hologram. The median puncture and radiation exposure times were 27 min and 120 s, respectively. No intraoperative or major postoperative complications occurred. Matched pair analysis with the standard ECIRS group revealed a significantly shorter radiation exposure time for the 3D MR group (p < 0.001) even though the puncture time was longer in comparison to the standard group (p < 0.001). Finally, use of 3D MR led to a higher success rate for renal puncture at the first attempt (100% vs 50%; p = 0.032). The main limitations of the study are the small sample size and manual overlapping of the rigid hologram models.
Our experience demonstrates that 3D MR guidance for renal puncture is feasible and safe. The procedure proved to be effective, with the inferior calyx correctly punctured in all cases, and was associated with a low intraoperative radiation exposure time because of the MR guidance.
Three-dimensional virtual models visualized as holograms and intraoperatively overlapped on the patient's real anatomy seem to be a valid new tool for guiding puncture of the kidney through the skin for minimally invasive treatment.
尽管技术和技术创新不断，但经皮肾镜取石术仍然是最具挑战性的步骤。该操作具有最陡峭的学习曲线，并且有损伤周围器官和肾脏损伤的风险。
评估三维混合现实（3DMR）全息图在建立经皮肾穿刺入路和引导针方面的可行性。
设计、设置和参与者：本前瞻性研究纳入了 2019 年 7 月至 2020 年 1 月期间因肾结石接受 3DMR 内镜下联合肾内手术（ECIRS）的 10 例患者。选择了一组接受标准手术的回顾性患者进行配对分析。
对于接受 3DMR ECIRS 的患者，全息图与真实解剖结构重叠，以在经皮穿刺过程中指导外科医生。在标准组中，仅通过超声和透视引导程序。
使用 χ 检验和 Kruskal-Wallis 检验分别测试组间术前和术后患者特征的差异，用于分类变量和连续变量。结果以连续变量的中位数和四分位数范围以及分类变量的频率和百分比表示。
10 例患者接受 3DMR ECIRS。在所有情况下，均按使用重叠全息图的计划正确穿刺下极盏。中位穿刺和辐射暴露时间分别为 27 分钟和 120 秒。术中或术后均无重大并发症发生。与标准 ECIRS 组的匹配对分析显示，3DMR 组的辐射暴露时间明显缩短（p<0.001），尽管与标准组相比，穿刺时间更长（p<0.001）。最后，3DMR 组首次尝试肾穿刺成功率更高（100% vs 50%；p=0.032）。该研究的主要局限性是样本量小和刚性全息图模型的手动重叠。
我们的经验表明，3DMR 引导肾穿刺是可行且安全的。该程序有效，所有情况下均正确穿刺下极盏，并且由于 MR 引导，术中辐射暴露时间较低。
通过皮肤微创治疗肾脏时，将三维虚拟模型可视化作为全息图并在手术期间与患者的真实解剖结构重叠，似乎是一种有效的新工具。
