Percutaneous puncture during PCNL: new perspective for the future with virtual imaging guidance

Context Large and complex renal stones are usually treated with percutaneous nephrolithotomy (PCNL). One of the crucial steps in this procedure is the access to the collecting system with the percutaneous puncture and this maneuver leads to a risk of vascular and neighboring organs' injury. In the last years, the application of virtual image-guided surgery has gained wide diffusion even in this specific field. Objectives To provide a short overview of the most recent evidence on current applications of virtual imaging guidance for PCNL. Evidence acquisition A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use virtual imaging guidance for PCNL. Evidence synthesis 3D virtual navigation technology for PCNL was first used in urology with the purpose of surgical training and surgical planning; subsequently, the field of surgical navigation with different modalities (from cognitive to augmented reality or mixed reality) had been explored. Finally, anecdotal preliminary experiences explored the potential application of artificial intelligence guidance for percutaneous puncture. Conclusion Nowadays, many experiences proved the potential benefit of virtual guidance for surgical simulation and training. Focusing on surgery, this tool revealed to be useful both for surgical planning, allowed to achieve a better surgical performance, and for surgical navigation by using augmented reality and mixed reality systems aimed to assist the surgeon in real time during the intervention.

Automated summary

Virtual imaging guidance for PCNL has shown promising applications in surgical training, planning, and navigation, while artificial intelligence guidance also holds potential for percutaneous puncture. This technology has the ability to assist surgeons in real-time during the intervention, improving surgical performance.