Presentation Authors: Egor Parkhomenko*, Boston, MA, Mitchell O'Leary, Orange, CA, Shoaib Safiullah, Colombia, MO, Francis Jefferson, Sartaaj Walia, Orange, CA, Ryan James, Seattle, WA, Cyrus Lin, Roshan Patel, Orange, CA, Kamaljot Kaler, Calgary, Canada, Jaime Landman, Ralph Clayman, Orange, CA
Introduction: Percutaneous nephrolithotomy (PCNL) requires urologists to have detailed knowledge of the stone and its relationship to the renal anatomy. Immersive virtual reality (iVR) provides patient-specific 3D models that might be beneficial in this regard. Our objective is to evaluate the impact of iVR on surgeon's preoperative planning, clinical outcomes, and patient education.
Methods: Four endourologists used iVR models (Figure 1) to acquaint themselves with the renal anatomy prior to PCNL in 25 patients. iVR renderings were also viewed by patients using the same head-mounted Oculus Rift display (Facebook Inc.). Using a Likert-type scale (1=strongly disagree to 5=strongly agree), surgeons rated their understanding of the anatomy after viewing CT images only and then after the iVR experience; using a similar Likert-type scale, patients recorded their experience with iVR. Next, iVR patients were matched with 25 retrospective non-iVR patients with similar age, ASA, BMI, stone burden, gender, and nephrostomy tract location. Student's t-test (Excel) was used for data analysis.
Results: iVR improved surgeons' understanding of the optimal calyx of entry and the stone's location, size/orientation (p < 0.01) (Table 1). iVR altered the surgical approach in 10 (40%) cases. Patients strongly agreed that iVR reduced their preoperative anxiety (p < 0.05). In the retrospective matched-paired analysis, the iVR group had a significant decrease in fluoroscopy time (139 vs. 269 sec, p=0.027) and blood loss (66 vs. 206 mL, p=0.019) as well as a trend toward fewer nephrostomy needle passes (1.13 vs. 1.46 passes; p=0.10) and a higher 100% stone-free rate (9/25 vs 5/25, p=0.15).
Conclusions: iVR prior to PCNL improved urologists' understanding of the renal anatomy, altered the operative approach, and mitigated patients' preoperative anxiety. Clinically, iVR decreased both fluoroscopy time and blood loss and trended toward fewer access tracts and higher stone free rates.