擴展現實應用於逆行性腎臟內手術訓練

顏敬恒¹ 賴姿君¹李俊德¹蒙恩²

國防醫學院 三軍總醫院松山分院 泌尿外科¹三軍總醫院 外科部²

Mobile extended reality applied in training of retrograde intrarenal surgery

Ching-Heng Yen^1,, Zi Jun, Lai ¹, Chunte Lee ¹, En Meng ²

¹Division of Urology, Tri-Service General Hospital SongShan Branch, National Defense Medical Center ,Taipei, Taiwan

²Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Purpose: We want to establish the similarity, impact, usefulness, and feasibility of Mobile Extended Reality(MXR) upper urinary tract model involving the pelvicalyceal system and the kidney model that contains kidney stones for preoperative simulation training.

Materials and Methods: Images obtained from CT urogram will be imported to a 3D scanning software, PACS-DICOM viewer. Then, the images will be exported to new extension files and will be imported in 3D slicer (http://www.slicer.org), an open-source software for medical image processing and informatics and for 3D-visualization to reconstruct the 3D CT images of the pelvicalyceal systems and kidney models and perform regional cutting. The files will be further exported to Standard Triangulation Language (STL) files. Eventually, to remove contrast material which is not connected and to generate structure of single pelvicalyceal system of each individual, the STL files will be then imported to Meshmixer (Autodesk). The renal CT images of the three subjects were converted into 3D stereo image models by MIMICs, and the 3D image models of the different hard and soft groups, including the skeletal vessels, should be clear enough for the presentation of the images at different levels after conversion to MXR images. The converted 3D image model is then converted into an XR image model that can be displayed on a mobile device by using MAKAR's built-in system functions, as well as a QR code to open the image model.

Results: We recruited 3 subjects, completed CT image collection, and successfully created an MXR image of kidney stones through modeling software and manually identifying image locations. The MXR images we created can adjust the display of organ hierarchies according to needs, such as kidneys, blood vessels, bones, etc., and can mark the location of stones. Kidney stone MXR imaging has the potential to be a surgical training model after being combined with other technologies.

Conclusions: The interactive stereoscopic images provided through the MXR are expected to provide new ways to assist in surgical planning and simulation training for flexible ureteroscopes, they also could applied to training for other more difficult surgical procedures.