Skip to main content
SpringerLink
Log in

Augmented reality simulator for ultrasound-guided percutaneous renal access

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Traditional training for percutaneous renal access (PCA) relies on apprenticeship, which raises concerns about patient safety, limited training opportunities, and inconsistent quality of feedback. In this study, we proposed the development of a novel augmented reality (AR) simulator for ultrasound (US)-guided PCA and evaluated its validity and efficacy as a teaching tool.

Methods

Our AR simulator allows the user to practice PCA on a silicone phantom using a tracked needle and US probe emulator under the guidance of simulated US on a tablet screen. 6 Expert and 24 novice participants were recruited to evaluate the efficacy of our simulator.

Results

Experts highly rated the realism and usefulness of our simulator, reflected by the average face validity score of 4.39 and content validity score of 4.53 on a 5-point Likert scale. Comparisons with a Mann–Whitney U test revealed significant differences \((p<0.05)\) in performances between the experts and novices on 6 out of 7 evaluation metrics, demonstrating strong construct validity. Furthermore, a paired T-test indicated significant performance improvements \(({p}<{0.05})\) of the novices in both objective and subjective evaluation after training with our simulator.

Conclusion

Our cost-effective, flexible, and easily customizable AR training simulator can provide opportunities for trainees to acquire basic skills of US-guided PCA in a safe and stress-free environment. The effectiveness of our simulator is demonstrated through strong face, content, and construct validity, indicating its value as a novel training tool.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Miller NL, Matlaga BR, Lingeman JE (2007) Techniques for fluoroscopic percutaneous renal access. J Urol 178(1):15–23

    Article  PubMed  Google Scholar 

  2. Skolarikos A, Alivizatos G, de la Rosette JJMCH (2005) Percutaneous nephrolithotomy and its legacy. Eur Urol 47(1):22–28

    Article  PubMed  Google Scholar 

  3. Darren B, Hassan R, Naeem B, Jennifer B, David BB, David TT, Marshall LS, Thomas C (2019) Techniques—ultrasound—guided percutaneous nephrolithotomy: how we do it. Can Urol Assoc J 14(3)

  4. Ng CF (2014) Training in percutaneous nephrolithotomy: the learning curve and options. Arab J Urol 12(1):54–57

    Article  PubMed  Google Scholar 

  5. Lee CL, Anderson JK, Monga M (2004) Residency training in percutaneous renal access: does it affect urological practice? J Urol 171(2):592–595

    Article  PubMed  Google Scholar 

  6. Samia H, Khan S, Lawrence J, Delaney CP (2013) Simulation and its role in training. Clin Colon Rectal Surg 26(1):47–55

    Article  PubMed  PubMed Central  Google Scholar 

  7. Noureldin YA, Andonian S (2016) Simulation for percutaneous renal access: where are we? J Endourol 31(S1):S10–S19

    Article  PubMed  Google Scholar 

  8. Mishra S, Kurien A, Patel R, Patil P, Ganpule A, Muthu V, Ravindra B, Desai M (2010) Validation of virtual reality simulation for percutaneous renal access training. J Endourol Endourol Soc 24:635–40

    Article  Google Scholar 

  9. Singh P, Sarkar L, Sethi HS, Gupta VS (2015) A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in indian patients. Indian J Ophthalmol 63(10):779–784

    Article  PubMed  PubMed Central  Google Scholar 

  10. Badash I, Burtt K, Solorzano CA, Carey JN (2016) Innovations in surgery simulation: a review of past, current and future techniques. In: Annals of translational medicine (focus on: innovations and technology in surgery’), vol 4, no 23

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vijayakumar M, Balaji S, Singh A, Ganpule A, Sabnis R, Desai M (2019) A novel biological model for training in percutaneous renal access. Arab J Urol 17(4):292–297. https://doi.org/10.1080/2090598X.2019.1642600

    Article  PubMed  PubMed Central  Google Scholar 

  12. Veneziano D, Smith A, Reihsen T, Speich J, Sweet RM (2014) The simportal fluoro-less c-arm trainer: an innovative device for percutaneous kidney access. J Endourol 29(2):240–245

    Article  PubMed  Google Scholar 

  13. Tai Y, Wei L, Zhou H, Peng J, Li Q, Li F, Zhang J, Shi J (2019) Augmented-reality-driven medical simulation platform for percutaneous nephrolithotomy with cybersecurity awareness. Int J Distrib Sens Netw 15(4):1550147719840173

    Article  Google Scholar 

  14. Noureldin YA, Hoenig DM, Zhao P, Elsamra SE, Stern J, Gaunay G, Motamedinia P, Okeke Z, Rastinehad AR, Sweet RM (2018) Incorporation of the fluoroless c-arm trainer at the american urological association hands on training percutaneous renal access. World J Urol 36(7):1149–1155

    Article  PubMed  Google Scholar 

  15. Ng FC, Yam WL, Lim TYB, Teo JK, Ng KK, Lim SK (2017) Ultrasound-guided percutaneous nephrolithotomy: advantages and limitations. Invest Clin Urol 58(5):346–352

    Article  Google Scholar 

  16. Pacioni A, Carbone M, Freschi C, Viglialoro R, Ferrari V, Ferrari M (2015) Patient-specific ultrasound liver phantom: materials and fabrication method. Int J Comput Assist Radiol Surg 10(7):1065–1075

    Article  PubMed  Google Scholar 

  17. Bartha L, Lasso A, Pinter C, Ungi T, Keri Z, Fichtinger G (2013) Open-source surface mesh-based ultrasound-guided spinal intervention simulator. Int J Comput Assist Radiol Surg 8(6):1043–1051

    Article  PubMed  Google Scholar 

  18. Barsom EZ, Graafland M, Schijven MP (2016) Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 30(10):4174–83

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gallagher AG, Ritter EM, Satava RM (2003) Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 17(10):1525–1529

    Article  PubMed  Google Scholar 

  20. Schijven MP, Jakimowicz JJ (2005) Validation of virtual reality simulators: key to the successful integration of a novel teaching technology into minimal access surgery. Minim Invas Ther Allied Technol 14(4/5):244–246

    Article  Google Scholar 

  21. Xia W, Chen ECS, Pautler SE, Peters TM (2019) A global optimization method for specular highlight removal from a single image. IEEE Access 7:125976–125990

    Article  Google Scholar 

  22. Gerovich O, Marayong P, Okamura AM (2004) The effect of visual and haptic feedback on computer-assisted needle insertion. Comput Aided Surg 9(6):243–249

    PubMed  Google Scholar 

Download references

Funding

This study was funded by Canadian Foundation for Innovation (20994), Canadian Institutes of Health Research (FDN 201409), and Natural Sciences and Engineering Research Council (RGPIN 2014 04504).

Author information

Authors and Affiliations

  1. School of Biomedical Engineering, Western University, London, Canada

    Yanyu Mu, Roy Eagleson & Terry M. Peters

  2. Robarts Research Institute, London, Canada

    Yanyu Mu & Terry M. Peters

  3. Department of Medical Imaging, Western University, London, Canada

    David Hocking & Gregory J. Garvin

  4. Division of Urology, Western University, London, Canada

    Zhan Tao Wang

  5. Department of Electrical and Computer Engineering, Western University, London, Canada

    Roy Eagleson

Authors
  1. Yanyu Mu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Hocking
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhan Tao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory J. Garvin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roy Eagleson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Terry M. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yanyu Mu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. This article does not contain patient data beyond the anonymized retrospective imaging data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mu, Y., Hocking, D., Wang, Z.T. et al. Augmented reality simulator for ultrasound-guided percutaneous renal access. Int J CARS 15, 749–757 (2020). https://doi.org/10.1007/s11548-020-02142-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-020-02142-x

Keywords

Search

Navigation