BJUI compass · 2026
Mixed reality applications in percutaneous stone surgery: A systematic review and meta-analysis of stone-free rate and perioperative complications.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Lo Christopher Yong-Zyn, Toscano Frida, Ng John Joson, Jingzeng Du, Khandekhar Archan, Shah Hemendra, Marcovich Robert, Ojalvo Julio, Saini Sarvesh, Katz Jonathan
Аннотация
OBJECTIVES: The aim of this study is to evaluate the effect of mixed reality (MR)-assisted percutaneous nephrolithotomy (PCNL) on stone-free rate (SFR), perioperative complications and operative efficiency.
METHODS: A search of PubMed, Embase and Web of Science from inception to February 2026 followed PRISMA guidelines. Studies comparing MR-assisted versus standard fluoroscopic or ultrasound-guided PCNL were included. Risk of bias was assessed using RoB2 and ROBINS-I. Random-effects meta-analyses calculated standardized mean differences (SMD) or risk ratios (RR) with 95% confidence intervals (CI).
RESULTS: Nine studies (n = 774; 378 MR-assisted, 396 control) met inclusion criteria; eight studies (n = 730; 356 MR-assisted, 374 control) were included in meta-analysis. MR modalities included immersive virtual reality (VR) planning, holographic MR and CT-ultrasound (US) fusion navigation. The MR-assisted group had modest improvements in SFR compared to the control group (RR = 1.09; 95% CI 1.00-1.18; p = 0.044; I 2 = 17.3%, p = 0.29). Complication rates were similar between MR-assisted and standard approaches. There was no statistically significant difference in puncture time between MR-assisted and standard groups (SMD = -0.64; 95% CI -2.22 to 0.93; p = 0.42), with considerable heterogeneity. Similarly, there was no statistically significant difference in operative duration (SMD = -0.22; 95% CI -0.66 to +0.23; p = 0.34). While not meeting the threshold for pooled meta-analysis, narratively, we found that MR-assistance also reduced puncture attempts, blood loss and fluoroscopy time.
CONCLUSIONS: MR-assisted PCNL is associated with an apparent increase in SFR while maintaining comparable operative parameters and complication rates compared with standard techniques. Heterogeneity in these technologies and their applications limits generalizability. Larger, adequately powered standardized trials are recommended to interrogate key outcome measures including SFR and complication rates.
METHODS: A search of PubMed, Embase and Web of Science from inception to February 2026 followed PRISMA guidelines. Studies comparing MR-assisted versus standard fluoroscopic or ultrasound-guided PCNL were included. Risk of bias was assessed using RoB2 and ROBINS-I. Random-effects meta-analyses calculated standardized mean differences (SMD) or risk ratios (RR) with 95% confidence intervals (CI).
RESULTS: Nine studies (n = 774; 378 MR-assisted, 396 control) met inclusion criteria; eight studies (n = 730; 356 MR-assisted, 374 control) were included in meta-analysis. MR modalities included immersive virtual reality (VR) planning, holographic MR and CT-ultrasound (US) fusion navigation. The MR-assisted group had modest improvements in SFR compared to the control group (RR = 1.09; 95% CI 1.00-1.18; p = 0.044; I 2 = 17.3%, p = 0.29). Complication rates were similar between MR-assisted and standard approaches. There was no statistically significant difference in puncture time between MR-assisted and standard groups (SMD = -0.64; 95% CI -2.22 to 0.93; p = 0.42), with considerable heterogeneity. Similarly, there was no statistically significant difference in operative duration (SMD = -0.22; 95% CI -0.66 to +0.23; p = 0.34). While not meeting the threshold for pooled meta-analysis, narratively, we found that MR-assistance also reduced puncture attempts, blood loss and fluoroscopy time.
CONCLUSIONS: MR-assisted PCNL is associated with an apparent increase in SFR while maintaining comparable operative parameters and complication rates compared with standard techniques. Heterogeneity in these technologies and their applications limits generalizability. Larger, adequately powered standardized trials are recommended to interrogate key outcome measures including SFR and complication rates.