Pilot Assessment of Immersive Virtual Reality Renal Models as an Educational and Preoperative Planning Tool for Percutaneous Nephrolithotomy.

Abstract

Percutaneous nephrolithotomy (PCNL) requires the urologist to have detailed knowledge of the stone and its relationship with the renal anatomy. Immersive virtual reality (iVR) provides patient-specific three-dimensional models that might be beneficial in this regard. Our objective is to present the initial experience with iVR in surgeon planning and patient preoperative education for PCNL. From 2017 to 2018 four surgeons, each of whom had varying expertise in PCNL, used iVR models to acquaint themselves with the renal anatomy before 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 with 25 retrospective matched-paired non-iVR patients. Student's t-test was used to analyze collected data. iVR improved surgeons' understanding of the optimal calix 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.