Novel Visualization Tool for Percutaneous Renal Puncture Training Using Augmented Reality Technology

We aim to develop a novel visualization tool for percutaneous renal puncture training based on augmented reality (AR) and compare the needle placement performance of this AR system with ultrasound-guided freehand navigation in phantoms. A head-mounted display-based AR navigation system was developed using the Unity3D software and Visual Studio to enable the overlay of the preoperative needle path and the complex anatomical structures onto a phantom in real time. The spatial location of the stationary phantom and the percutaneous instrument motion were traced by a Qualisys motion capture system. To evaluate the tracking accuracy, 15 participants (7 males and 8 females) performed a single needle insertion using AR navigation (the number of punctures n = 75) and ultrasound-guided freehand navigation ( n = 75). The needle placement error was measured as the Euclidean distance between the actual needle tip and the virtual target by MicronTracker. All participants demonstrated a superior needle insertion efficiency when using the AR-assisted puncture method compared with the ultrasound-guided freehand method. The needle insertion error of the ultrasound-guided method showed an increased error compared with the AR method (5.54mm ± 2.59mm, 4.34mm ± 2.10mm, respectively, p < 0.05). The ultrasound-guided needle placements showed an increased time compared with the AR method (19.08 s ± 3.59 s, 15.14 s ± 2.72 s, respectively, p < 0.0001). Our AR training system facilitates the needle placement performance and solves hand-eye coordination problems. The system has the potential to increase efficiency and effectiveness of percutaneous renal puncture training.