Feasibility of a novel technique using 3-dimensional modeling and augmented reality for access during percutaneous nephrolithotomy in two different ex-vivo models
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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.
KeywordsPercutaneous nephrolithotomy Access 3-Dimensional Augmented reality Software Modeling
We would like to thank Yunus Emre KIYMAZ (PhD student), Ibrahim Hakan UGRAS, Selman KIRBAG and Emre BUYUKASLAN for their invaluable contributions to the study.
This project was funded by The Scientific and Technological Research Council of Turkey (TÜBİTAK) with the Grant No. 114S348.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest or financial ties to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study design was approved by the Selcuk University School of Medicine Ethics Committee (approval number: 2013/7, approval date: 13.03.2013).
Informed consent was obtained from all individual participants included in the study.
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