| Objective: To evaluate the best operating position and operating channel for the operator’s comfort during operation,and to explore the value of mixed reality technology in establishing comfortable operating channels in percutaneous nephrolithotomy.Methods: A total of 40 patients with calculi who received percutaneous nephrolithotomy in the urology department of our hospital from June 2020 to December 2021 by the same physician team were retrospectively analyzed.Among them,19 patients（experimental group）underwent percutaneous nephrolithotomy by establishing comfortable operating channels guided by mixed reality technology,including 16 males,3 females,10 left and 9 right,and 21 patients（control group）underwent percutaneous nephrolithotomy under the guidance of B-ultrasound,including 17 males,4 females,8 left and 13 right.One case of left kidney stone and one case of right kidney stone were selected to make a 1:1 kidney 3D printing model.Based on the principle of ergonomics,simulation and model experiments combined with questionnaire survey were used to simulate the process of nephroscope entering and leaving the percutaneous nephrolithotomy operation channel in prone position and lateral position.Seven doctors with relevant position operation experience in our hospital were evaluated for the comfort of operation,so as to obtain a more comfortable position and comfortable puncture area.CTU examination was performed before operation in both groups.In the experimental group,original CT image data were obtained,and 3D visualization data were established using Materialise Mimics20.0,then imported into the mixed reality surgical planning system（Z-Space and Hololens 2 glasses）for preoperative planning,doctor-patient communication and holographic 3D image model establishment.During the operation,Hololens2 glasses were used to accurately match and integrate the three-dimensional visual model with the patients,and real-time navigation was used to guide the surgical treatment.Results: The comfort of operation in prone position was better than that in lateral position,and the sense of anxiety,muscle fatigue of waist and leg and comfort of posture coordination were improved compared with that in lateral position（P < 0.05）.Taking the target calyceal fornix as the puncture point,the angle between the nephroscope and the horizontal plane is 45°～ 60°.And it is more comfortable to operate in the area where the left and right swing amplitude is within 45°.The 40 cases were successfully operated in a more comfortable prone position without serious complications.There were 2 cases of residual stones,1 case of bleeding in the experimental group,4 cases of residual stones,2 cases of bleeding and 1 case of bleeding combined with fever in the control group.There was no significant difference in the incidence of complications between the two groups（P > 0.05）.The patient satisfaction in the process of doctor-patient communication in the experimental group was significantly higher than that in the control group（P < 0.001）.The mean first tracts puncture time in the experimental group was 6（6,8）min and that in the control group was 10（8,13）min.There was significant difference between the two groups（P < 0.05）.The operation time was 80（70,95）min in the experimental group and 110（90,152）min in the control group.There was significant difference between the two groups（P < 0.05）.There was no significant difference in one-stage stone-free rate,postoperative hospitalization time,preoperative and postoperative hemoglobin changes and the coincidence rate of renal calyces puncture between the two groups（P > 0.05）.Conclusion: We constructed the concept of comfortable operation channel,and at home and abroad,we first evaluated the surgical position and puncture range of PCNL to improve the operator’s comfort.The operation comfort of percutaneous nephrolithotomy in prone position is better than that in lateral position.Taking the target calyceal fornix as the puncture point,the angle between the nephroscope and the horizontal plane is 45°～ 60°.And it is more comfortable to operate in the area where the left and right swing amplitude is within 45°.The intraoperative application of ergonomics can reduce intraoperative fatigue,prevent chronic skeletal and muscle injury,improve the comfort of intraoperative operation,and help to ensure the quality of operation under high intensity work.This can also be used in other kidney surgery（for example,kidney tumor surgery,etc.）.The establishment of comfort operation channel guided by mixed reality technology can effectively reduce the puncture time and operation time.The application of three-dimensional visualization model can effectively improve the preoperative communication between doctors and patients,and the patient satisfaction is higher. |
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