Puncture path planning algorithm of flexible needle in percutaneous nephrolithotomy with a hybrid NSGA optimizer

Percutaneous nephrolithotomy is the standard treatment for large or irregularly shaped kidney stones, especially staghorn calculus. However, establishing a precise and safe puncture is challenging and requires extensive training for the surgeon. Navigation surgery is a commonly employed technique that facilitates the puncture through generating a path before surgery. One critical challenge for navigation is skin-kidney path planning due to the complex anatomical deconstruction of the kidney as well as the irregular shape of kidney stones.

In this paper, we propose a hybrid strategy puncture path planning algorithm, where we follow a 2-step flow path that considers the selection of puncture renal calyces and planning of a B-spine curve path. We imitate the decision-making process of the clinician in selecting the puncture calyx based on the projective area of the calculi to be cleared. We summarize subjective judgment and clinical experience during puncture, where parametric optimization indicators are proposed to realize the optimization of puncture path.

An optimal frontier consisting of puncture pathways focused on different puncture factors can be generated from the proposed algorithm, where the physician can choose the path that works best under real circumstances. Results in 2D simulation show that the planned pathway is similar to that planned by a urologist.

The proposed 2-Step hybrid strategy reaches a balance on both optimal effect and efficiency. This automatic planning method based on the long axis section of the kidney can quickly and autonomously provide physicians with a series of optimized puncture paths, and provide auxiliary guidance for clinicians, especially young physicians. Nevertheless, the proposed method shows considerable potential in percutaneous nephrolithotomy surgical demonstration and teaching, and can integrated into robotic surgical navigation system.