Virtual reality gives urologists immersive pre-surgical view of kidneys
3-D assessment led to improvements in surgical planning
January 15, 2019
UCI Health urologists are using virtual reality to immerse themselves in a 3-D look at a patient’s anatomy as they prepare to surgically remove kidney stones or tumors.
The UCI-developed system converts as many as 2,500 CT images into a colorful virtual model of kidneys, blood vessels and surrounding anatomy. Surgeons don a headset and control a joystick to rotate, enlarge and move parts of the body to plan the best surgical approach.
“This is exquisite anatomical knowledge,” said Ralph V. Clayman, MD, professor of medicine, Department of Urology, UCI School of Medicine. “We think it’s an advance that’s going to help. Our goal is to create things that will allow more urologists to do a better job for patients.”
In a study of 25 patients who underwent removal of kidney stones at UCI Medical Center, use of virtual reality led physicians to revise their surgical plan in 40 percent of cases. For 20 patients who underwent tumor removal, the surgical plan changed in 60 percent of cases. The system has also been used in a small number of surgeries to remove a kidney for donation.
Clayman, principal investigator of the study, made a presentation on the virtual reality system at the World Congress of Endourology last fall in Paris.
Surgeons who used the virtual reality system before removing kidney stones reported a better understanding of the size and shape of the stone, its location and optimal point of entry, the UCI Health study found.
“It’s personalized,” Clayman said. “Everybody’s kidney is different. Stones all vary in size.”
Kidney stones affect about 1 in 11 people in the United States and have been on the rise. A minimally invasive procedure to remove kidney stones, called percutaneous nephrolithotomy or PCNL, requires careful planning.
Normally, Clayman said he would view the patient’s CT scan and put the images together in his mind. The process is much simpler in virtual reality, where he can manipulate images for a better view, such as by moving an artery or rib.
It takes about two hours to create a patient’s model, so urologists are reserving virtual reality for complicated cases. But Clayman, who said he spends about 10 or 15 minutes reviewing a virtual reality model, said he’s hopeful a simple app can be created to simplify the process.
The system, which was developed for about $2,000 by combining existing software, could also be used for other parts of the body and to help teach young doctors in training. The model also can give patients a glimpse inside their bodies and reduce their anxiety before surgery.
Clayman said the next step is to launch a randomized controlled trial to test the virtual reality technology.
“My hypothesis is that it will be highly significant in improving surgical outcomes,” Clayman said. “There’s a suggestion that not only is it ‘cool’ but it’s actually of value. The patients invariably love it and they find it very helpful in being able to better understand their surgery.”
UCI Health comprises the clinical enterprise of the University of California, Irvine. Patients can access its physicians at offices throughout Orange County and at its main campus, UCI Medical Center in Orange, California. The 417-bed acute care hospital provides tertiary and quaternary care, ambulatory and specialty medical clinics, and behavioral health and rehabilitation services. U.S. News & World Report has listed it among “America’s Best Hospitals” for 18 consecutive years. UCI Medical Center features Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program, Level I trauma center and Level II pediatric trauma center, and it’s the primary teaching hospital for the UCI School of Medicine. UCI Health serves a region of more than 3 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook and Twitter.