Category: Education, Simulation & Virtual Reality

MP19-14 - Virtual Reality: An Educational and Preoperative Planning Tool for Percutaneous Nephrolithotomy

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : Traditional preoperative planning for percutaneous nephrolithotomy (PCNL) utilizes standard 2D computed tomography (CT). In contrast, virtual reality (VR) allows the user to view and manipulate the patient-specific renal anatomy in a 3D environment. Herein, we present our initial experience with VR among patients undergoing PCNL.

Methods : Following IRB approval, using 3D Slicer software, CT scans were used to create 3D VR models for viewing with a head-mounted display (Oculus Rift, Facebook Inc.) of 25 patients scheduled for PCNL (Figure 1). Four experienced surgeons (RVC, JL, KK, RMP) rated their pre-operative understanding (0 = poor; 10 = excellent) of the pertinent anatomy using CT alone vs. CT with VR for each of their respective patients. Surgeons and patients recorded their impressions after exposure to the VR technology using a Likert-type scale (1=strongly disagree to 5=strongly agree).

Results : Compared to viewing the CT alone, the VR models improved surgeons’ understanding of the renal stone’s location, size, and orientation while aiding selection of the optimal calyx of entry (p<0.01) (Table 1). After viewing the VR model, surgeons felt it improved their confidence with the selected surgical approach (4.76/5, range 4-5); they also felt it was a valuable surgical planning tool (4.72/5, range 4-5) and would be useful for teaching residents (4.92/5, range 4-5). In addition, the VR model altered the surgical approach in 10 (40%) cases. On the post-operative assessment, the surgeons rated the VR models as correlating well with the experienced surgical anatomy (4.40-4.68/5, range 2-5). Patients strongly agreed (4.95/5, range 4-5) that the VR experience improved their understanding of the planned PCNL and reduced their preoperative anxiety.

Conclusions : VR technology helped surgeons to better understand the renal anatomy prior to a planned PCNL; in 40% of cases, the VR experience resulted in an alteration of the surgical approach.  In addition, the VR experience improved patient comprehension and comfort with the planned surgery.

Egor Parkhomenko

Boston Medical Center
Boston, Massachusetts

Shoaib Safiullah

Columbia, Missouri

Mitchell L. O'Leary

Clinical Researcher
University of California, Irvine, Department of Urology
Orange, California

Michael Owyong

Orange, California

Sartaaj Walia

Orange, California

Ryan James

Seattle, Washington

Cyrus Lin

Orange, California

Roshan M. Patel

Assistant Clinical Professor
University of California, Irvine, Department of Urology
Orange, California

Kamaljot S. Kaler

Clinical Assistant Professor
University of California, Irvine; University of Calgary
Orange, California

Jaime Landman

Professor and Chair
Department of Urology, University of California, Irvine, Orange, CA
Orange, California

Professor Landman completed his medical training at Columbia University. He then completed his Urology residency at Mt. Sinai Hospital in New York before moving to St. Louis to complete his minimally invasive urology training at Washington University under the guidance of Dr. Ralph Clayman. Dr. Landman’s fellowship training focused on the minimally invasive treatment of renal diseases.

Prof. Landman focuses on developing new clinical approaches to minimally invasive and more effective treatments for surgical renal diseases such as renal cell carcinoma, urolithiasis and ureteropelvic junction obstruction. For the past decade, his clinical practice has been focused almost exclusively on the minimally invasive management of kidney disease with a focus on renal oncology and urolithiasis.

Since 2002 Dr. Landman has directed an active minimally invasive urology laboratory. His laboratory has focused largely on innovative minimally invasive solutions in the diagnosis and treatment of urologic malignancies, kidney stones and the development of minimally invasive surgical technologies.

A major focus of Dr. Landman’s efforts has been the didactic and technical training of students, residents and fellows. Dr. Landman has had an active role in medical student and resident education since 2001. Since 2002 Dr. Landman has been actively directing the Endourology sanctioned clinical and research fellowship, and he was until recently the program director for the UC Irvine Urology residency. Dr. Landman engendered and currently directs the LIFT (Leadership Innovation Fellowship Training) program at UC Irvine and has focused on helping medical students become academic leaders in Urology.

A current focus of Dr. Landman’s research remains didactic and technical training for students, residents and fellows. His research team continues to develop novel strategies for surgical education.

Ralph V. Clayman

University of California, Irvine, Department of Urology
Orange, California