Presented by: Adib Rahman
Toowoomba hospital

Introduction

PCNL is the preferred treatment of kidney stones > 20mm in diameter, with Fluoroscopy employed to achieve access. THis can be challenging to conceptualise the 3D anatomy especially in difficult cases, and multiple punctures often required to gain entry to correct calyx. Augmented reality involves overlaying digital information onto real world objects/places to enhance user experience. This can be achieved using optical see-through head mounted display (OST-HMD) such as the HoloLens.Augmented reality may allow access into the collecting system during PCNL. We aim to use AR as an adjunct for PCNL, especially in difficult cases.

Materials

We conducted a prospective, scoping proof-of-concept trial. We constructed patient-unique models of the kidney and associated stones and used augmented reality to achieve puncture into the collecting system and confirm entry intraoperatively with fluoroscopy. Pre-operative CT IVP was used to generate 3D model of the patient’s kidney and stones. Blender (Blender Foundation) and Unity (Unity Technologies) used to create final models and user interface, subsequently uploaded onto HoloLens unit.

 

Results

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Five patients have undergone successful supine AR guided PCNL. All were able to achieve puncture into renal calyx using AR guidance on a first attempt. There were no complications encountered in achieving entry. 1 patient underwent  asubsequent laser lithotripsy to clear small fragments.

Conclusion

We were able to establish proof-of-concept and able to enter calyx and achieve stone clearance. We foresee this being a useful adjunct for, assisting trainees in learning PCNL, visualising complex anatomy and stone burden.

 

Funding

Toowoomba Hospital Foundation

Lead Authors

Kale Munien,
Toowoomba Hospital

Aiyapa Ajjikuttira,
Toowoomba Hospital

Chris Camilleri,
University of Queensland