Image-Guided Surgical Planning for Percutaneous Nephrolithotomy Using CTRs: A Phantom-Based Study

In this paper, we validate the effectiveness of the optimal planning algorithms we have developed for devising surgical plans for Percutaneous Nephrolithotomy (PCNL) using patient-specific Concentric-Tube Robots (CTRs). To do so, we built a life-sized phantom model of the right hemithorax, replicating the anatomy of a patient who suffered from kidney stone and underwent conventional PCNL. Two-dimensional CT scans of the phantom model and its 3D reconstruction enabled the creation of a surgical plan using our planning algorithms based on a puncture into the mid-pole of the kidney. This was compared with two other percutaneous tracts involving punctures into the lower and upper calyces for comparison. The optimal mid-pole plan achieved 84% stone coverage, significantly outperforming the lower pole (58 %) and upper pole (45 %) plans. These results validate the effectiveness of the algorithms and align with simulation-based findings from previous studies, which reported an average volume coverage of 81.6±19.6 % in clinical cases.