Dados do Trabalho

Título

RANDOMIZED CLINICAL TRIAL: IMMERSIVE VIRTUAL REALITY FOR PERCUTANEOUS NEPHROLITHOTOMY

Introdução e Objetivo

Percutaneous nephrolithotomy (PCNL) is the standard of care for stones larger than 2cm; however, it is also associated with significant morbidity. Therefore, understanding the kidney anatomy and the stone size and location in relation to the collecting system is crucial for a safe, successful PCNL. We sought to determine the impact of immersive virtual reality (iVR) on PCNL outcomes.

Método

Randomized clinical trial from 2019 to 2022 including 125 patients, of which 50 patients were randomized to the CT-only group and 75 to the iVR group. Using an open-source software (3D Slicer), CT scans were rendered into 3D models, which were uploaded on an Oculus Meta Quest 2, allowing the surgeon to manipulate anatomical landmarks and visualize the trajectory of the percutaneous access (Figure 1). The main outcome was stone-free rate (absolute stone free, < 2 mm remnants, and < 4mm remnants). The secondary outcome was the rate of significant postoperative complications (Clavien ≥2).

Resultados

In the iVR group, there was a statistically significant improvement in absolute stone-free rate (40% vs 23%, p = 0.048) and < 2mm remnants (62% vs 42%, p = 0.030). There was also a statistically significant reduction in complications (0% vs 11%, p = 0.013) (Figure 2). Additionally, there was a trend towards an increased volume of stone ablated per minute of surgery in the CT+iVR group (p=0.07). Of note, 28% of surgeons changed the calyx of choice for PCNL after viewing the iVR model.  

Conclusão

The iVR model significantly improved stone-free rates and reduced complications of PCNL.