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-guidedfreehand navigation in phantoms.A head-mounted display-based AR navigation system was developed usingthe Unity3D software and Visual Studio to enable the overlay of the preoperative needle path and the complexanatomical 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 ofpunctures n=75)and ultrasound-guided freehand navigation(n=75).The needle placement error was measuredas the Euclidean distance between the actual needle tip and the virtual target by MicronTracker.All participantsdemonstrated a superior needle insertion efficiency when using the AR-assisted puncture method compared withthe ultrasound-guided freehand method.The needle insertion error of the ultrasound-guided method showed anincreased error compared with the AR method(5.54 mm±2.59 mm,4.34 mm±2.10 mm,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 andeffectiveness of percutaneous renal puncture training.