PURPOSE Percutaneous nephrolithotomy (PCNL) is the procedure of choice for the management of complex or large renal stones. A major challenge for the surgeon, however, is the need to assimilate the nearly 2000 static images from a CT scan into a functional mental image to enable surgical planning. Accordingly, we investigated the potential of immersive virtual reality (iVR) to enhance surgical planning and its impact on the outcomes among patients undergoing PCNL. MATERIALS AND METHODS Between 2019 and 2023, 175 patients undergoing PCNL were preoperatively randomized into a CT-only group (N = 89) or a CT+iVR group (N = 86). CT scans were rendered into iVR models that allowed the surgeon not only to visualize and manipulate each patient's relevant anatomy but also simulate the percutaneous approach to the proposed calyx. Postoperative CT scans were defined as absolute stone-free, < 2 mm remnants, or 2.1 to 4 mm remnants. RESULTS Preoperative visualization of the iVR model resulted in a changed calyx of entry in 30% of cases. The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs 20.22%, P = .043) and overall < 4 mm remnant rate (62.79% vs 48.20%, P = .044). Clavien-Dindo II+IIIa complications were less in the iVR group (3.48% vs 12.30%, P = .03). The results were independent of the surgeon's years of PCNL experience. CONCLUSIONS Preoperative iVR model visualization benefited surgeons and patients alike. From a surgical standpoint, viewing the iVR model resulted in a safer, more effective percutaneous stone removal procedure.

中文翻译：

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应用于经皮肾镜取石术的术前沉浸式虚拟现实 （iVR）：一项关于手术计划和临床结果的前瞻性随机临床研究。


目的 经皮肾镜取石术 （PCNL） 是治疗复杂或大肾结石的首选手术。然而，外科医生面临的一个主要挑战是需要将 CT 扫描的近 2000 个静态图像吸收到功能性心理图像中，以便制定手术计划。因此，我们调查了沉浸式虚拟现实 （iVR） 增强手术计划的潜力及其对 PCNL 患者预后的影响。材料和方法 2019 年至 2023 年间，175 例接受 PCNL 的患者在术前被随机分为仅 CT 组 （N = 89） 或 CT+iVR 组 （N = 86）。CT 扫描被渲染成 iVR 模型，使外科医生不仅可以可视化和操纵每位患者的相关解剖结构，还可以模拟拟议花萼的经皮入路。术后 CT 扫描定义为绝对无结石、< 2 mm 残余物或 2.1 至 4 mm 残余物。结果 iVR 模型的术前可视化导致 30% 的病例的入口花萼发生变化。CT+iVR 组绝对结石清除率 （33.70% vs 20.22%，P = .043） 和总体 < 4 mm 残余率 （62.79% vs 48.20%，P = .044） 显著改善。iVR 组的 Clavien-Dindo II+IIIa 并发症较少 （3.48% vs 12.30%，P = .03）。结果与外科医生多年的 PCNL 经验无关。结论 术前 iVR 模型可视化使外科医生和患者都受益。从手术的角度来看，查看 iVR 模型可以实现更安全、更有效的经皮取石手术。