Preoperative Immersive Virtual Reality Applied to Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Study of Surgical Planning and Clinical Outcomes.

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 to 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.