Mixed Reality Combined with Three-Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation

Mixed Reality Navigation in Hip Fusion Conversion: A Novel Utilization of Advanced Technology: A Case Report

CASE

A 32-year-old woman with a history of hip fusion presented with significant lower back, hip, and knee pain as well as severely limited hip mobility and function. Single-stage fusion takedown and conversion to total hip arthroplasty (THA) was performed using augmented reality navigation. At 1 year, the patient was pain free with improved function. This study is the first to report the technique and outcomes of surgical fusion conversion to THA, using mixed reality navigation.

CONCLUSION

Mixed reality navigation in complex conversion THA can be useful for identifying the patient's true acetabulum and for patient-specific acetabular component placement to maximize outcomes.

The Effectiveness of Virtual Reality, Augmented Reality, and Mixed Reality Rehabilitation in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used in postoperative rehabilitation of total knee arthroplasty (TKA). The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of XR-based rehabilitation in TKA compared to conventional rehabilitation.

METHODS

In this study, we searched PubMed (MEDLINE), Embase (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to February 15, 2023 for eligible studies. A total of 14 randomized controlled trials with 989 patients were included in our study. The primary outcomes were pain and function. The secondary outcomes were anxiety and quality of life. A systematic review and meta-analysis was performed.

RESULTS

The pooled data indicated XR-based rehabilitation significantly improved the visual analog scale (standardized mean difference [SMD] = -0.31, 95% Confidence Interval [CI] [-0.47 to -0.15], P = .0001), the Western Ontario and McMaster Universities Osteoarthritis Index (SMD = -0.46, 95% CI [-0.86 to -0.06], P = .02), range of motion (SMD = 0.40, 95% CI [0.09 to 0.72], P = .01), and anxiety scores (mean difference = -3.95, 95% CI [-7.76 to -0.13], P = .04) than conventional rehabilitation, but Timed Up and Go test and quality of life were similar in the 2 groups.

CONCLUSION

This systematic review and meta-analysis found XR-based rehabilitation improved pain, function, and anxiety, but not quality of life in TKA compared to conventional rehabilitation within 1 month postoperatively. Based on the pooled results, we suggested that XR-based rehabilitation may have benefit in patients' postoperative rehabilitation in TKA.

Augmented reality-assisted versus conventional total hip arthroplasty: a systematic review and meta-analysis

BACKGROUND

Extended reality (XR), including virtual reality, augmented reality (AR), and mixed reality, has been used to help achieve accurate acetabular cup placement in total hip arthroplasty (THA). This study aimed to compare the differences between XR-assisted and conventional THA.

METHODS

In this systematic review and meta-analysis, electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to September 10, 2023. The outcomes were accuracy of inclination and anteversion, duration of surgery, and intraoperative blood loss. Meta-analysis was performed using Review Manager 5.4 software.

RESULTS

A total of five studies with 396 patients were included in our study. The pooled results indicated AR-assisted THA had better accuracy of inclination and anteversion than conventional THA (SMD = - 0.51, 95% CI [- 0.96 to - 0.07], P = 0.02; SMD = - 0.96, 95% CI [- 1.19 to - 0.72], P < 0.00001), but duration of surgery and intraoperative blood loss were similar in the two groups.

CONCLUSION

This systematic review and meta-analysis found that AR-assisted THA had better accuracy of inclination and anteversion than conventional THA, but the duration of surgery and intraoperative blood loss were similar in the two groups. Based on the pooled results, we suggested that AR can provide more precise acetabular cup placement than conventional methods in THA.

Mixed reality in primary retroperitoneal tumour surgery: Evaluation of preoperative and intraoperative application value

OBJECTIVE

To evaluate the feasibility and application value of mixed reality technology (MR) in Primary retroperitoneal tumour (PRT) surgery.

METHODS

From 276 patients who underwent PRT resection at the First Affiliated Hospital of Xi'an Jiaotong University, we screened 46 patients who underwent MR-assisted retroperitoneal tumour resection and 46 patients who underwent tumour resection without MR assistance. The intraoperative and postoperative recovery of the patients in both groups were compared, and the reliability and validity of the application of MR were further examined using the Likert scale.

RESULTS

There was a significant difference in the mean intraoperative bleeding volume between the two groups, but it was reduced in the MR group. The results of the Likert scale showed higher scores in the MR group than non-MR group.

CONCLUSIONS

MR can be used to assist PRT resection and has great potential to improve the rate of complete retroperitoneal tumour resection.

Application of Virtual and Augmented Reality Technology in Hip Surgery: Systematic Review

BACKGROUND

Virtual and augmented reality (VAR) represents a combination of current state-of-the-art computer and imaging technologies and has the potential to be a revolutionary technology in many surgical fields. An increasing number of investigators have developed and applied VAR in hip-related surgery with the aim of using this technology to reduce hip surgery-related complications, improve surgical success rates, and reduce surgical risks. These technologies are beginning to be widely used in hip-related preoperative operation simulation and training, intraoperative navigation tools in the operating room, and postoperative rehabilitation.

OBJECTIVE

With the aim of reviewing the current status of virtual reality (VR) and augmented reality (AR) in hip-related surgery and summarizing its benefits, we discussed and briefly described the applicability, advantages, limitations, and future perspectives of VR and AR techniques in hip-related surgery, such as preoperative operation simulation and training; explored the possible future applications of AR in the operating room; and discussed the bright prospects of VR and AR technologies in postoperative rehabilitation after hip surgery.

METHODS

We searched the PubMed and Web of Science databases using the following key search terms: ("virtual reality" OR "augmented reality") AND ("pelvis" OR "hip"). The literature on basic and clinical research related to the aforementioned key search terms, that is, studies evaluating the key factors, challenges, or problems of using of VAR technology in hip-related surgery, was collected.

RESULTS

A total of 40 studies and reports were included and classified into the following categories: total hip arthroplasty, hip resurfacing, femoral neck fracture, pelvic fracture, acetabular fracture, tumor, arthroscopy, and postoperative rehabilitation. Quality assessment could be performed in 30 studies. Among the clinical studies, there were 16 case series with an average score of 89 out of 100 points (89%) and 1 case report that scored 81 (SD 10.11) out of 100 points (81%) according to the Joanna Briggs Institute Critical Appraisal Checklist. Two cadaveric studies scored 85 of 100 points (85%) and 92 of 100 points (92%) according to the Quality Appraisal for Cadaveric Studies scale.

CONCLUSIONS

VR and AR technologies hold great promise for hip-related surgeries, especially for preoperative operation simulation and training, feasibility applications in the operating room, and postoperative rehabilitation, and have the potential to assist orthopedic surgeons in operating more accurately and safely. More comparative studies are necessary, including studies focusing on clinical outcomes and cost-effectiveness.

The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis

BACKGROUND

Extended reality (XR), including virtual reality (VR), augmented reality (AR), and mixed reality (MR), has been used in the training of total hip arthroplasty (THA). This study aims to examine the effectiveness of XR training in THA.

METHODS

In this systematic review and meta-analysis, we searched PubMed (MEDLINE), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to September 2022 for eligible studies. The Review Manager 5.4 software was applied to compare accuracy of inclination and anteversion, and surgical duration between XR training and conventional methods.

RESULTS

We identified 213 articles, of which 4 randomized clinical trials and 1 prospective controlled study including 106 participants met inclusion criteria. The pooled data indicated the XR training had better accuracy of inclination and shorter surgical duration than conventional methods (MD = -2.07, 95% CI [- 4.02 to -0.11], P = 0.04; SMD = -1.30, 95% CI [- 2.01 to -0.60], P = 0.0003), but the accuracy of anteversion was similar in the two groups.

CONCLUSIONS

This systematic review and meta-analysis found XR training had better accuracy of inclination and shorter surgical duration than conventional methods in THA, but the accuracy of anteversion was similar. Based on the pooled results, we suggested that XR training can better improve trainees' surgical skills than conventional methods in THA.

Treatment effect analysis of curettage for jaw cysts based on volumetric assessment and image registration

The study was conducted to develop a visual and intuitive quantitative evaluation method for maxillary cystic lesions after curettage. Mimics 16.0 and Geomagic Studio 2013 were used to form a precise reconstruction of the cystic lesion morphology of 60 cases; the average reduction rates and 95% confidence interval were calculated. Computed tomography (CT) registration was performed before and after surgery to observe morphology features of the bone regeneration of the cystic area. The average reduction rates (RR) of the cysts after curettage were (43.56 ± 16.79)%, (54.33 ± 17.15)% and (68.53 ± 15.99)% at 3 months, 6 months and 12 months after surgery, respectively. The average monthly reduction rates (MRR) were (12.07 ± 4.35)%, (8.16 ± 2.84)% and (5.35 ± 1.52)% at 3 months, 6 months and 12 months after surgery, respectively. Correlation analysis by comparing with each group showed that the effect of sex and age in the 3-month group and the initial size in the 12-month group on RR and MRR were statistically significant. Within the limitations of the study it seems that the chosen approach for quantitative evaluation of the therapeutic effect of curettage for jaw cystic lesions might facilitate visual and quantitative follow-up of cyst curettage and timely detection of recurrence.

Case report: Resection of a massive primary sacrococcygeal mature teratoma in an adult using 3-dimensional reconstruction and mixed reality technology

Introduction

Teratomas are rare neoplasms that arise from pluripotent germ cells. Sacrococcygeal teratomas are often diagnosed in infants but are rare in adults; a mature teratoma can contain hair, teeth, bony tissue, and other mature tissue types. Herein, we report for the first time a patient with a teratoma containing intact bones that formed a pseudoarthrosis.

Case report

A 49-year-old woman was admitted to hospital after a massive life-long sciatic tumor had begun to grow larger over the past year. A 16 cm × 25 cm solid mass with a clear boundary was palpable in the sacrococcygeal region. Radiography, computed tomography, and magnetic resonance imaging indicated a sacrococcygeal teratoma, although blood alpha-fetoprotein levels were normal. The teratoma was completely excised using 3-dimensional reconstruction mixed reality (MR) technology with no notable complications. Postoperative pathological examination of the excised lesion confirmed a mature teratoma. Interestingly, two intact irregular bones that formed a pseudoarthrosis were isolated; one was 11 cm and the other 6 cm. The patient is currently healthy and has experienced no recurrences.

Conclusion

Sacrococcygeal teratomas are rare, especially in adults, and often comprised lots of components, such as fat, bony tissue. However, it's first reported that formation of pseudoarthrosis in this case so far. It is difficult for surgeons to achieve complete excision without complications owing to the complex anatomic structure of the sacrum. The 3-dimensional reconstruction and mixed reality (MR) technology based on computed tomography can provide spatial visualization, which allows surgeons to examine the teratoma at different angles preoperatively. Combining 3-dimensional reconstruction and mixed reality (MR) technology in this case facilitated complete resection and prevented recurrence.

Application of a novel osteotomy instrumentation as a substitute tool in total hip arthroplasty

BACKGROUND

Mechanical failure, power shortage, and inadvertent contamination of the oscillating saw occasionally occurs in actualizing femoral neck osteotomy during total hip arthroplasty (THA); however, no appropriate alternative solution is currently available. This study aimed to introduce a novel osteotomy instrumentation (fretsaw, jig, cable passer hook) as a substitute tool while the oscillating saw was unavailable during THA.

METHODS

This study included 40 patients (40 hips) who underwent femoral neck osteotomy during primary THA using the new osteotomy instrumentation (n = 20) and the oscillating saw (n = 20). Clinical data and intraoperative findings of all patients were evaluated.

RESULTS

The mean osteotomy time was 22.3 ± 3.1 s (range, 17-30 s) and 29.4 ± 3.7 s (range, 25-39 s) in the oscillating saw group and in the new osteotomy instrumentation group, respectively (P < 0.001). The Harris Hip Score (HHS) improved in both groups; the mean HSS was 82.3 ± 2.5 and 83.3 ± 3.5 in the oscillating saw group and new osteotomy instrumentation group at 6 months after surgery, respectively (P = 0.297).

CONCLUSIONS

The original osteotomy instrumentation can be an ideal substitute tool for femoral neck osteotomy in THA, especially when the oscillating saw is unavailable or malfunctioning.

Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI

Background: Augmented Reality (AR) represents an innovative technology to improve data visualization and strengthen the human perception. Among Human–Machine Interaction (HMI), medicine can benefit most from the adoption of these digital technologies. In this perspective, the literature on orthopedic surgery techniques based on AR was evaluated, focusing on identifying the limitations and challenges of AR-based healthcare applications, to support the research and the development of further studies. Methods: Studies published from January 2018 to December 2021 were analyzed after a comprehensive search on PubMed, Google Scholar, Scopus, IEEE Xplore, Science Direct, and Wiley Online Library databases. In order to improve the review reporting, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used. Results: Authors selected sixty-two articles meeting the inclusion criteria, which were categorized according to the purpose of the study (intraoperative, training, rehabilitation) and according to the surgical procedure used. Conclusions: AR has the potential to improve orthopedic training and practice by providing an increasingly human-centered clinical approach. Further research can be addressed by this review to cover problems related to hardware limitations, lack of accurate registration and tracking systems, and absence of security protocols.

Mixed Reality Technology in Total Knee Arthroplasty: An Updated Review With a Preliminary Case Report

Background

Augmented reality and mixed reality have been used to help surgeons perform complex surgeries. With the development of technology, mixed reality (MR) technology has been used to improve the success rate of complex hip arthroplasty due to its unique advantages. At present, there are few reports on the application of MR technology in total knee arthroplasty. We presented a case of total knee arthroplasty with the help of mixed reality technology.

Case Presentation

We presented a case of a 71-year-old woman who was diagnosed with bilateral knee osteoarthritis with varus deformity, especially on the right side. After admission, the right total knee arthroplasty was performed with the assistance of MR technology. Before the operation, the three-dimensional virtual model of the knee joint of the patient was reconstructed for condition analysis, operation plan formulation, and operation simulation. During the operation, the three-dimensional virtual images of the femur and tibia coincided with the real body of the patient, showing the osteotomy plane designed before the operation, which can accurately guide the completion of osteotomy and prosthesis implantation.

Conclusions

As far as we know, this is the first report on total knee arthroplasty under the guidance of mixed reality technology.

What’s new in artificially intelligent joint surgery in China? The minutes of the 2021 IEEE ICRA and literature review

Objective

To outline the main results of the 2021 International Conference on Robotics and Automation (ICRA 2021) of the Institute of Electrical and Electronics Engineers (IEEE) and review the advances in artificially intelligent joint surgery in China.

Methods

The keynote speeches of the 2021 ICRA were summarized in detail, and publications indexed by five core electronic databases (PubMed, Cochrane, Medline, Embase and CNKI) were systematically surveyed (cutoff date: July 30, 2021) in terms of the main topics of the conference. Publications directly related to artificially intelligent joint surgery in China were identified by using the search strategies of (robotic AND arthroplasty OR replacement), (navigation AND arthroplasty OR replacement), (artificial intelligent AND arthroplasty OR replacement), and (mixed reality AND arthroplasty OR replacement) and systemically reviewed.

Results

While robot-assisted arthroplasty in China is mainly performed using robots made in other countries (e.g., Mako from Stryker, USA), China’s domestic R&D of robots and clinical studies of robotic joint surgery have made some achievements. Although reports on the safety, effectiveness and clinical efficacy of China’s domestic robot-assisted joint surgery were presented at conferences, they have rarely been published in journals. Existing data indicate that, after the learning curve is overcome, robot-assisted hip and knee replacement surgery can fully achieve the established goals of precision and individualization and can significantly improve the accuracy of prosthesis placement angle and the recovery of the mechanical axis as compared with conventional surgery. The downside is that the low level of intelligentization and individualization means that existing designs are not conducive to personalization during surgery, resulting in low cost-effectiveness.

Conclusion

The safety and efficacy of domestic robot-assisted arthroplasty in China are well documented, and its accuracy and short-term clinical efficacy have been reported. However, the long-term clinical efficacy and the cost-effectiveness of large-scale clinical application of this technique warrants further study. The inadequacies of robot-assisted surgery should be remedied through the deep integration of medicine, engineering and the network.

AUGMENTED REALITY NAVIGATION FRAMEWORK FOR TOTAL HIP ARTHROPLASTY SURGERY

In a total hip arthroplasty surgery, correctly implanting the artificial acetabulum and the femoral head is essential for a successful treatment. An augmented reality (AR) navigation framework is proposed in this paper to provide accurate surgical guidance in a total hip arthroplasty procedure. The AR framework consists of three parts: (1) preoperative surgical planning to generate virtual information for AR; (2) computer vision-based tracking for the real-time localization of both acetabular cup positioner and bony landmarks during surgery; (3) registration of a virtual object onto a real-world operative field to properly overlay the preoperative surgical planning data onto a three-dimensional (3D)-printed pelvis model. The cost-effective framework is designed with our clinical partner based on real surgical conditions. The bony landmarks are automatically detected and used for the registration between virtual and real objects. The AR performance is evaluated with a pelvis model, and it presents mean errors of 2.2[Formula: see text]mm and 0.8∘ in position and orientation, respectively, between real and virtual spaces. These small errors are within the tolerance of positive surgical outcomes.

Mixed reality for visualization of orthopedic surgical anatomy

In the modern era, preoperative planning is substantially facilitated by artificial reality technologies, which permit a better understanding of patient anatomy, thus increasing the safety and accuracy of surgical interventions. In the field of orthopedic surgery, the increase in safety and accuracy improves treatment quality and orthopedic patient outcomes. Artificial reality technologies, which include virtual reality (VR), augmented reality (AR), and mixed reality (MR), use digital images obtained from computed tomography or magnetic resonance imaging. VR replaces the user’s physical environment with one that is computer generated. AR and MR have been defined as technologies that permit the fusing of the physical with the virtual environment, enabling the user to interact with both physical and virtual objects. MR has been defined as a technology that, in contrast to AR, enables users to visualize the depth and perspective of the virtual models. We aimed to shed light on the role that MR can play in the visualization of orthopedic surgical anatomy. The literature suggests that MR could be a valuable tool in orthopedic surgeon’s hands for visualization of the anatomy. However, we remark that confusion exists in the literature concerning the characteristics of MR. Thus, a more clear description of MR is needed in orthopedic research, so that the potential of this technology can be more deeply understood.

Simulated operation combined with patient-specific instrumentation technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study

OBJECTIVE

Over the past seven years, our team has designed a simulated operation combined with patient-specific instrumentation (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it in the clinic. This study aimed to evaluate the differences between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application, and postoperative curative effect.

METHODS

We retrospectively analyzed SMOT data collected from our hospital between October 2014 and December 2018. Patients (n = 28) were enrolled and divided into CO (n = 17) and SO-PSI (n = 11) groups; mean follow-up time was 33.4 (range, 13 to 59) months. We statistically analyzed and compared perioperative data, accuracy of preoperative planning, intraoperative application, difference between pre- and post-operative radiologic ankle angles, changes in American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of ankle motion, and Takakura stage after surgery.

RESULTS

All ankle alignments and positions were recovered for both groups. Compared with the CO group, the SO-PSI group had a shorter mean operating time and postoperative hospital stay, a decreased number of fluoroscopy examinations, lower albumin reduction, longer preoperative planning time and preoperative hospital stay, and increased hospitalization expenses. In the SO-PSI group, comparison of ankle angles at preoperative planning and postoperatively revealed good correlation, while this was not the case in the CO group. Mean tibial ankle center discrepancy for the SO-PSI group was 1.86 ± 1.06 mm. On follow-up, all radiologic parameters for the two groups improved significantly; however, the improvement of the tibial anterior surface angle and tibiotalar tilt angle for the SO-PSI group were more obvious than those for the CO group. AOFAS score, VAS score, ankle range of motion, and Takakura stage improved after surgery in both groups; however, the improvements in the SO-PSI group were greater than those in the CO group overall.

CONCLUSIONS

SO-PSI technology can facilitate accurate and rapid preoperative planning for SMOT. In general, compared with conventional technology, SO-PSI has advantages for preoperative planning, intraoperative application, and postoperative curative effect.

Registration Techniques for Clinical Applications of Three-Dimensional Augmented Reality Devices

Many clinical procedures would benefit from direct and intuitive real-time visualization of anatomy, surgical plans, or other information crucial to the procedure. Three-dimensional augmented reality (3D-AR) is an emerging technology that has the potential to assist physicians with spatial reasoning during clinical interventions. The most intriguing applications of 3D-AR involve visualizations of anatomy or surgical plans that appear directly on the patient. However, commercially available 3D-AR devices have spatial localization errors that are too large for many clinical procedures. For this reason, a variety of approaches for improving 3D-AR registration accuracy have been explored. The focus of this review is on the methods, accuracy, and clinical applications of registering 3D-AR devices with the clinical environment. The works cited represent a variety of approaches for registering holograms to patients, including manual registration, computer vision-based registration, and registrations that incorporate external tracking systems. Evaluations of user accuracy when performing clinically relevant tasks suggest that accuracies of approximately 2 mm are feasible. 3D-AR device limitations due to the vergence-accommodation conflict or other factors attributable to the headset hardware add on the order of 1.5 mm of error compared to conventional guidance. Continued improvements to 3D-AR hardware will decrease these sources of error.

Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

Background

Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.

Methods

We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.

Results

Mean intraoperative fluoroscopy time was 3.95 ± 1.78 h; IFAU in 16 patients (16 ft) was the same as the preoperative plan; mean surgery time was 28.16 ± 10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2% ± 2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.

Conclusions

The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

The clinical application value of mixed-reality-assisted surgical navigation for laparoscopic nephrectomy

Purpose

Laparoscopic nephrectomy (LN) has become the preferred method for renal cell carcinoma (RCC). Adequate preoperative assessment or intraoperative navigation is key to the successful implementation of LN. The aim of this study was to evaluate the clinical application value of mixed‐reality–assisted surgical navigation (MRASN) in LN.

Patients and Methods

A total of 100 patients with stage T1N0M0 renal tumors who underwent laparoscopic partial nephrectomy (LPN) or laparoscopic radical nephrectomy (LRN) were prospectively enrolled and divided into a mixed‐reality‐assisted laparoscopic nephrectomy (MRALN) group (n = 50) and a non–mixed‐reality‐assisted laparoscopic nephrectomy (non‐MRALN) group (n = 50). All patients underwent renal contrast‐enhanced CT scans. The CT DICOM data of all patients in the MRALN group were imported into the mixed‐reality (MR) postprocessing workstation and underwent holographic three‐dimensional visualization (V3D) modeling and MR displayed, respectively. We adopted the Likert scale to evaluate the clinical application value of MRASN. The consistency of evaluators was assessed using the Cohen kappa coefficient (k).

Results

No significant differences in patient demographic indicators between the MRALN group and the non‐MRALN group (P > .05). The subjective score of MRASN clinical application value in operative plan formulation, intraoperative navigation, remote consultation, teaching guidance, and doctor‐patient communication were higher in the MRASN group than in the non‐MRASN group (all P < .001). There were significantly more patients for whom LPN was successfully implemented in the MRALN group than in the non‐MRALN group (82% vs 46%, P < .001). The MRALN group had a shorter operative time (OT) and warm ischemia time (WIT) and less estimated blood loss (EBL) than the non‐MRALN group (all P < .001).

Conclusion

MRASN is helpful for operative plan formulation, intraoperative navigation, remote consultation, teaching guidance, and doctor‐patient communication. MRALN may effectively improve the successful implementation rate of LPN and reduce the OT, WIT, and EBL.