Lasmanovich Rinat, Dagan Maayan, Hemo Orel, Tejman-Yarden Shai, Zilberman Dorit E, Vazhgovsky Oliana, Dotan Zohar A, Kleinmann Nir, Shvero Asaf
Department of Urology, Sheba Medical Center, Ramat Gan, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Urolithiasis. 2025 Apr 9;53(1):69. doi: 10.1007/s00240-025-01730-3.
Achieving renal access during percutaneous nephrolithotomy is challenging, with a complication rate of 10-20%. This study aims to assess a novel technique for planning access to the renal collecting system using augmented reality (AR). Using Digital Imaging and Communications in Medicine software (DICOM 2-print), we generated 3-dimensional (3D) models of patients with different types of kidney stones (staghorn, lower pole, and pelvic stones) who underwent PCNL between 2018 and 2022. After viewing the patient's CT scans, surgeons explored the anatomical models using an AR system with a stereoscopic 3D lens array display. Using questionnaires, we quantitatively estimated the model's contribution on a scale of "1" ("poor") to "5" ("excellent") to the surgeon's understanding of stone location, patient anatomy, and ease of access compared to 2D CT imaging. A total of 38 questionnaires were completed by 13 urologists. Estimating renal location, renal pelvis, and stone mass were better demonstrated by AR (5 vs. 4, p < 0.001). The orientation of adjacent organs was better understood using AR (5 vs. 4, p = 0.004). In 86.8% of cases, surgeons preferred using AR models both before and during surgery, with 69.2% suggesting that AR could enhance procedural safety. The time frames for testing the models differed between senior and junior practitioners (p = 0.016) and were significantly reduced with model experience (p < 0.001). When comparing CT to 3D imaging, AR models provide a better understating of stone location, patient anatomy, and route of access to the collecting system. Further research is required to implement this innovative technique preoperatively and intra-operatively.
经皮肾镜取石术期间实现肾脏穿刺通道的建立具有挑战性,并发症发生率为10%-20%。本研究旨在评估一种使用增强现实(AR)技术规划进入肾集合系统通道的新技术。利用医学数字成像和通信软件(DICOM 2-print),我们生成了2018年至2022年间接受经皮肾镜取石术(PCNL)的不同类型肾结石(鹿角形结石、下极结石和盆腔结石)患者的三维(3D)模型。在查看患者的CT扫描图像后,外科医生使用带有立体3D透镜阵列显示器的AR系统探索解剖模型。通过问卷调查,我们以“1”(“差”)到“5”(“优秀”)的量表定量评估了该模型与二维CT成像相比,在帮助外科医生了解结石位置、患者解剖结构以及穿刺通道建立的难易程度方面的作用。13位泌尿外科医生共完成了38份问卷。AR在评估肾脏位置、肾盂和结石大小方面表现更佳(5分对4分,p<0.001)。使用AR能更好地理解相邻器官的方位(5分对4分,p=0.004)。在86.8%的病例中,外科医生在手术前和手术期间都更喜欢使用AR模型,69.2%的人认为AR可以提高手术安全性。高级和初级从业者测试模型的时间框架有所不同(p=0.016),且随着对模型的熟悉程度时间显著缩短(p<0.001)。与CT相比,AR模型能更好地理解结石位置、患者解剖结构以及进入集合系统的路径。需要进一步研究以在术前和术中应用这种创新技术。