Percutaneous nephrolithotomy (PCNL) requires the urologist to have detailed knowledge of the stone and its relationship to the renal anatomy. Immersive virtual reality (iVR) provides patient-specific 3D models that might be beneficial in this regard.
Our objective is to present the initial experience with immersive VR in surgeon planning and patient preoperative education for PCNL.
From 2017-2018 four surgeons, each of whom had expertise in PCNL, used immersive VR (iVR) models to acquaint themselves with the renal anatomy prior to PCNL among 25 patients. iVR renderings were also viewed by patients using the same head-mounted Oculus rift display. Surgeons rated their understanding of the anatomy with CT alone and then after CT+iVR; patients also recorded their experience with iVR. To assess the impact on outcomes, the 25 iVR study patients were compared to 25 retrospectively matched-paired non-iVR patients. Student's t-test (Microsoft Excel) was used to analyze collected data.
iVR improved surgeons' understanding of the optimal calyx of entry and the stone's location, size, and orientation (p<0.01). iVR altered the surgical approach in 10 (40%) cases. Patients strongly agreed that iVR improved their understanding of their stone disease and reduced their preoperative anxiety. In the retrospective matched-paired analysis, the iVR group had a statistically significant decrease in fluoroscopy time and blood loss as well as a trend toward fewer nephrostomy tracts and a higher stone-free rate.
iVR improved urologists' understanding of the renal anatomy and, altered the operative approach in 40% of cases. In addition, iVR improved patient comprehension of their surgery. Clinically, iVR had benefits with regard to decreased fluoroscopy time and less blood loss along with a trend toward fewer access tracts and higher stone free rates.
Journal of endourology. 2018 Nov 21 [Epub ahead of print]
Egor Parkhomenko, Mitchell O'Leary, Shoaib Safiullah, Sartaaj Walia, Michael Owyong, Cyrus Lin, Ryan James, Zhamshid Okhunov, Roshan M Patel, Kamaljot S Kaler, Jaime Landman, Ralph V Clayman
University of California Irvine, Urology, Orange, California, United States ; ., University of California, Irvine, Urology , 333 City Blvd W , Orange, California, United States , 92868 ; ., University of California Irvine, 8788, Urology , 333 City Boulevard West , Suite 2100 , Orange , Orange, California, United States , 92868 ; ., University of California Irvine, Urology, Orange, California, United States ; ., University of California Irvine, Urology, Orange, California, United States ; ., University of California Irvine, Urology, Orange, California, United States ; ., University of Washington, Seattle, United States ; ., University of California, Irvine, Urology , 333 City Boulevard, Suite 2100 , 333 City Boulevard, Suite 2100 , Orange, California, United States , 92868 ; ., University of California Irvine, 8788, Urology , 333 City Blvd West , Suite 2100 , Irvine, California, United States , 92697 ; ., University of California Irvine School of Medicine, 12219, Urology, Orange, California, United States., University of California Irvine, Urology , 333 City Blvd West , Orange, California, United States , 92868 ; ., Univ. of California, Irvine, Urology, Irvine, California, United States ; .