To explore the application value of ultrasound combined with mixed reality in percutaneous nephrolithotomy (PCNL).

One hundred patients with renal calculi treated in the Northern Theater General Hospital from March 2019 to March 2021 were randomly divided into two groups: the experimental group (n=50) and the control group (n=50). The experimental group received ultrasound combined with reality-assisted percutaneous renal puncture, while the control group received traditional CT image reading combined with intraoperative ultrasound localization to perform PCNL. HoloLens glasses (experimental group) or CT images (control group) were used to state the patient's condition and make the operation plan to the patients and their family members. The clinical indexes and general data such as puncture accuracy, puncture time, intraoperative blood loss, hospital stay, stage I stone clearance rate and postoperative complications were compared between the two groups by t-test, Mann-WhitneyU test and χ² test . All operations were performed by experienced urologists.

All patients completed the operation successfully. The accuracy of the first puncture in the experimental group and control group was 90% vs 74.0 %, the median puncture time was [8.3(7.3, 8.7)] vs [9.4(8.6, 10.8)] min, the median operative time was [75(45, 100)] vs [88(65, 122)] min, the median intraoperative blood loss was [30(20, 50)] vs [40(30, 50)]ml, and the median change value of Hb was [10.0(6.0, 17.5)] vs [18.0(14.2, 26.5)] g/L, and all the differences were statistically significant. These results suggest that compared with the traditional operation, the ultrasound combined with mixed reality has higher puncture accuracy, shorter puncture time, less intraoperative blood loss, lower postoperative Hb change, and shorter operation time. There was no significant difference in age, sex, BMI, stone size, stone side, STONE score, hospital stay and stage I stone clearance rate between the mixed reality group and the control group.

Ultrasound combined with mixed reality assisted navigation accords with the concept of accurate puncture, high puncture accuracy, less time consuming and bleeding, and the application of assisted location puncture in PCNL is helpful, safe and feasible, and can be used in clinic, which is worth recommending.