Preoperative Virtual Reality Surgical Rehearsal of Renal Access during Percutaneous Nephrolithotomy: A Pilot Study

Abstract

Percutaneous Nephrolithotomy (PCNL) is a procedure used to treat kidney stones. In PCNL, a needle punctures the kidney through an incision in a patient’s back and thin tools are threaded through the incision to gain access to kidney stones for removal. Despite being one of the main endoscopic procedures for managing kidney stones, PCNL remains a difficult procedure to learn with a long and steep learning curve. Virtual reality simulation with haptic feedback is emerging as a new method for PCNL training. It offers benefits for both novices and experienced surgeons. In the first case, novices can practice and gain kidney access in a variety of simulation scenarios without offering any risk to patients. In the second case, surgeons can use the simulator for preoperative surgical rehearsal. This paper proposes the first preliminary study of PCNL surgical rehearsal using the Marion Surgical PCNL simulator. Preoperative CT scans of a patient scheduled to undergo PCNL are used in the simulator to create a 3D model of the renal system. An experienced surgeon then planned and practiced the procedure in the simulator before performing the surgery in the operating room. This is the first study involving survival rehearsal using a combination of VR and haptic feedback in PCNL before surgery. Preliminary results confirm that surgical rehearsal using a combination of virtual reality and haptic feedback strongly affects decision making during the procedure.