International Urology and Nephrology

, Volume 51, Issue 1, pp 17–25 | Cite as

Feasibility of a novel technique using 3-dimensional modeling and augmented reality for access during percutaneous nephrolithotomy in two different ex-vivo models

  • Murat AkandEmail author
  • Levent Civcik
  • Ahmet Buyukaslan
  • Emre Altintas
  • Erdinc Kocer
  • Mustafa Koplay
  • Tibet Erdogru
Urology - Original Paper



We describe a novel technique that uses mathematical calculation software, 3-dimensional (3D) modeling and augmented reality (AR) technology for access during percutaneous nephrolithotomy (PCNL) and report our first preliminary results in two different ex-vivo models.


Novel software was created in order to calculate access point and angle by using pre-operative computed tomography (CT) obtained in 50 patients. Two scans, 27 s and 10 min after injection of contrast agent, were taken in prone PCNL position. By using DICOM objects, mathematical and software functions were developed to measure distance of stone from reference electrodes. Vectoral 3D modeling was performed to calculate the access point, direction angle and access angle. With specific programs and AR, 3D modeling was placed virtually onto real object, and the calculated access point and an access needle according to the calculated direction angle and access angle were displayed virtually on the object on the screen of tablet.


The system was tested on two different models—a stone placed in a gel cushion, and a stone inserted in a bovine kidney that was placed in a chicken—for twice, and correct access point and angle were achieved at every time. Accuracy of insertion of needle was checked by feeling crepitation on stone surface and observing tip of needle touching stone in a control CT scan.


This novel device, which uses software-based mathematical calculation, 3D modeling and AR, seems to ensure a correct access point and angle for PCNL. Further research is required to test its accuracy and safety in humans.


Percutaneous nephrolithotomy Access 3-Dimensional Augmented reality Software Modeling 



We would like to thank Yunus Emre KIYMAZ (PhD student), Ibrahim Hakan UGRAS, Selman KIRBAG and Emre BUYUKASLAN for their invaluable contributions to the study.


This project was funded by The Scientific and Technological Research Council of Turkey (TÜBİTAK) with the Grant No. 114S348.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest or financial ties to disclose.

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. The study design was approved by the Selcuk University School of Medicine Ethics Committee (approval number: 2013/7, approval date: 13.03.2013).

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Türk C, Knoll T, Petrik A (2015) European Association of Urology (EAU) Guidelines on urolithiasis. European Association of Urology 2015.
  2. 2.
    Rupel E, Brown R (1941) Nephroscopy with removal of stone following nephrostomy for obstructive calculous anuria. J Urol 46:177CrossRefGoogle Scholar
  3. 3.
    Goodwin WE, Casey WC, Woolf W (1955) Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 157:891–894CrossRefGoogle Scholar
  4. 4.
    Fernström I, Johansson B (1976) Percutaneous nephrolithotomy: a new extraction technique. Scand J Urol Nephrol 10:257–259CrossRefGoogle Scholar
  5. 5.
    Wickham JE, Kellett MJ (1981) Percutaneous nephrolithotomy. Br J Urol 53:297–299CrossRefGoogle Scholar
  6. 6.
    Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallurci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS Jr, EAU/AUA Nephrolithiasis Guideline Panel (2007) 2007 guideline for the management of ureteral calculi. J Urol 178:2418–2434CrossRefGoogle Scholar
  7. 7.
    Andonian S, Scoffone C, Louie MK, Gross AJ, Grabe M, Daels FP, Shah HN, de la Rosette JJ, CROES PCNL Study Group (2012) Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol 27:24–28CrossRefGoogle Scholar
  8. 8.
    Su LM, Stoianovici D, Jarrett TW, Patriciu A, Roberts WW, Cadeddu JA, Ramakumar S, Solomon SB, Kavoussi LR (2002) Robotic percutaneous access to the kidney: comparison with standard manual access. J Endourol 16:471–475CrossRefGoogle Scholar
  9. 9.
    Challacombe B, Patriciu A, Glass J, Aron M, Jarrett T, Kim F, Pinto P, Stoianovici D, Smeeton N, Tiptaft R, Kavoussi L, Dasgupta P (2005) A randomized controlled trial of human versus robotic and telerobotic access to the kidney as the first step in percutaneous nephrolithotomy. Comput Aided Surg 10:165–171CrossRefGoogle Scholar
  10. 10.
    Ko R, Razvi H (2007) C-arm laser positioning device to facilitate percutaneous renal access. Urology 70:360–361CrossRefGoogle Scholar
  11. 11.
    Mozer P, Conort P, Leroy A, Baumann M, Payan Y, Troccaz J, Chartier-Kastler E, Richard F (2007) Aid to percutaneous renal access by virtual projection of the ultrasound puncture tract onto fluoroscopic images. J Endourol 21:460–465CrossRefGoogle Scholar
  12. 12.
    Zarrabi AD, Conradie JP, Heyns CF, Scheffer C, Schreve K (2010) Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy. Int Braz J Urol 36:738–746CrossRefGoogle Scholar
  13. 13.
    Oliveira-Santos T, Peterhans M, Roth B, Reyes M, Nolte LP, Thalmann G, Weber S (2010) Computer aided surgery for percutaneous nephrolithotomy: clinical requirement analysis and system design. Conf Proc IEEE Eng Med Biol Soc 2010:442–445Google Scholar
  14. 14.
    Lazarus J, Williams J (2011) The locator: novel percutaneous nephrolithotomy apparatus to aid collecting system puncture—a preliminary report. J Endourol 25:747–750CrossRefGoogle Scholar
  15. 15.
    Huber J, Wegner I, Meinzer HP, Hallscheidt P, Hadaschik B, Pahernik S, Hohenfellner M (2011) Navigated renal access using electromagnetic tracking: an initial experience. Surg Endosc 25:1307–1312CrossRefGoogle Scholar
  16. 16.
    Rodrigues PL, Vilaça JL, Oliveira C, Cicione A, Rassweiler J, Fonsecca J, Rodrigues NF, Correia-Pinto J, Lima E (2013) Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience. J Urol 190:1932–1937CrossRefGoogle Scholar
  17. 17.
    Ritter M, Rassweiler MC, Hacker A, Michel MS (2013) Laser-guided percutaneous kidney access with the Uro Dyna-CT: first experience of three-dimensional puncture planning with an ex vivo model. World J Urol 31:1147–1151Google Scholar
  18. 18.
    Müller M, Rassweiler MC, Klein J, Seitel A, Gondan M, Baumhauer M, Teber D, Rassweiler JJ, Meinzer HP, Maier-Hein L (2013) Mobile augmented reality for computer-assisted percutaneous nephrolithotomy. Int J Comput Assist Radiol Surg 8:663–675CrossRefGoogle Scholar
  19. 19.
    Li H, Chen Y, Liu C, Li B, Xu K, Bao S (2013) Construction of a three-dimensional model for renal stones: comprehensive planning for percutaneous nephrolithotomy and assistance in surgery. World J Urol 31:1587–1592CrossRefGoogle Scholar
  20. 20.
    Hacker A, Wendt-Nordahl G, Honeck P, Michel MS, Alken P, Knoll T (2007) A biological model to teach percutaneous nephrolithotomy technique with ultrasound- or fluoroscopy- guided access. J Endourol 21:545–550CrossRefGoogle Scholar
  21. 21.
    Rassweiler JJ, Müller M, Fangerau M, Klein J, Goezen AS, Pereira P, Meinzer HP, Teber D (2012) iPad-assisted percutaneous access to the kidney using marker-based navigation: initial clinical experience. Eur Urol 61:627–631CrossRefGoogle Scholar
  22. 22.
    Bird VG, Fallon B, Winfield HN (2003) Practice patterns in the treatment of large renal stones. J Endourol 17:355–363CrossRefGoogle Scholar
  23. 23.
    Lee CL, Anderson JK, Monga M (2004) Residency training in percutaneous renal access: does it affect urological practice? J Urol 171:592–595CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.School of Medicine, Department of UrologySelcuk UniversityKonyaTurkey
  2. 2.Higher School of Vocational and Technical Sciences, Department of Computer TechnologiesSelcuk UniversityKonyaTurkey
  3. 3.Konya Teknokent, AE Kod TeknolojisiKonyaTurkey
  4. 4.Technical Education Faculty, Department of Electronic and Computer EducationSelcuk UniversityKonyaTurkey
  5. 5.School of Medicine, Department of RadiologySelcuk UniversityKonyaTurkey
  6. 6.UroKlinik -Center of Excellence in UrologyIstanbulTurkey
  7. 7.Selçuk Üniversitesi, Alaeddin Keykubat Kampüsü, Tıp Fakültesi HastanesiKonyaTurkey

Personalised recommendations