Technical aspects to maximize the hyperaccuracy three-dimensional (HA3D) computed tomography reconstruction for kidney stones surgery: a pilot study.

The aim of the current prospective pilot study was to describe a hyperaccuracy three-dimensional (HA3D) model reconstruction technique, specifically developed to maximize the visualization of the renal collecting system's anatomy, and its relationship with the stones, vessels and renal parenchyma, and to compare the HA3D virtual models with the intraoperative findings. The image acquisition was performed using a CT scanner (Toshiba, Aquilion Prime) and included the unenhanced, arterial, venous and excretory phases. The DICOM format CT images were processed by MEDICS Srl ( www.medics3d.com , Turin, Italy). In total, study included three patients with renal stone scheduled for non-papillary prone percutaneous nephrolithotomy (PCNL). The median age and BMI were 51 (range 49-54) and 25.5 (range 25.0-32.7), respectively. The median stone size was 1170 mm (range 830-1520) and median stone density was 1130 HU (range 600-1340). In all cases, the quality of the CT images acquired with our protocol was adequate to perform the HA3D reconstruction. Median operative and puncture time were 39.4 (range 35.2-44.0) and 1.9 (range 1.8-2.1) mins, respectively. The success rate for the first attempt of the percutaneous puncture was 100%, and only one PCNL tract was sufficient to complete the surgery. All three patients were stone-free on the third postoperative day. A dedicated imaging acquisition protocol and a tailored 3D model reconstruction process specifically developed for kidney stones treatment allow obtaining HA3D highly relevant models to greatly match intraoperative findings during PCNL with the potential of minimizing bleeding and organ injury complications.