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The advancements of technological devices and software are putting mixed reality in the frontline of teaching medical personnel. The Microsoft® HoloLens 2® offers a unique 3D visualization of a hologram in a physical, real environment and allows the urologists to interact with it. This review provides a state-of-the-art analysis of the applications of the HoloLens® in a medical and healthcare context of teaching through simulation designed for medical students, nurses, residents especially in urology. Our objective has been to perform a comprehensively analysis of the studies in PubMed/Medline database from January 2016 to April 2023. The identified articles that researched Microsoft HoloLens, having description of feasibility and teaching outcomes in medicine with an emphasize in urological healthcare, have been included. The qualitative analysis performed identifies an increasing use of HoloLens in a teaching setting that covers a great area of expertise in medical sciences (anatomy, anatomic pathology, biochemistry, pharmacogenomics, clinical skills, emergency medicine and nurse education, imaging), and above these urology applications (urological procedures and technique, skill improvement, perception of complex renal tumors, accuracy of calyx puncture guidance in percutaneous nephrolithotomy and targeted biopsy of the prostate) can mostly benefit from it. The future potential of HoloLens technology in teaching is immense. So far, studies have focused on feasibility, applicability, perception, comparisons with traditional methods, and limitations. Moving forward, research should also prioritize the development of applications specifically for urology. This will require validation of needs and the creation of adequate protocols to standardize future research efforts.

Introduction: We wanted to analyze the trend of publications in a period of 30 years from 1994 to 2023, on the application of ‘artificial intelligence (AI), machine learning (ML), virtual reality (VR), and radiomics in percutaneous nephrolithotomy (PCNL)’. We conducted this study by looking at published papers associated with AI and PCNL procedures, including simulation training, with preoperative and intraoperative applications. Materials and Methods: Although MeSH terms research on the PubMed database, we performed a comprehensive review of the literature from 1994 to 2023 for all published papers on ‘AI, ML, VR, and radiomics’ in ‘PCNL’, with papers in all languages included. Papers were divided into three 10-year periods: Period 1 (1994–2003), Period 2 (2004–2013), and Period 3 (2014–2023). Results: Over a 30-year timeframe, 143 papers have been published on the subject with 116 (81%) published in the last decade, with a relative increase from Period 2 to Period 3 of +427% (p = 0.0027). There was a gradual increase in areas such as automated diagnosis of larger stones, automated intraoperative needle targeting, and VR simulators in surgical planning and training. This increase was most marked in Period 3 with automated targeting with 52 papers (45%), followed by the application of AI, ML, and radiomics in predicting operative outcomes (22%, n = 26) and VR for simulation (18%, n = 21). Papers on technological innovations in PCNL (n = 9), intelligent construction of personalized protocols (n = 6), and automated diagnosis (n = 2) accounted for 15% of publications. A rise in automated targeting for PCNL and PCNL training between Period 2 and Period 3 was +247% (p = 0.0055) and +200% (p = 0.0161), respectively. Conclusion: An interest in the application of AI in PCNL procedures has increased in the last 30 years, and a steep rise has been witnessed in the last 10 years. As new technologies are developed, their application in devices for training and automated systems for precise renal puncture and outcome prediction seems to play a leading role in modern-day AI-based publication trends on PCNL.

Background: The 3D models’ use for surgical planning has recently gained an ever-wider popularity, in particular in the urological field. Different ways of fruition of this technology have been evaluated over the years. Today, new technological developments allow us to enjoy 3D models in the metaverse. Objectives: The aim of this study is to report the preliminary experience and surgeon’s perception of preoperative planning performed in the metaverse. Design: During the eleventh edition of the Techno-Urology Meeting, all the attendees enjoyed the metaverse experience (META_EXP) for pre-surgical planning of both robot-assisted radical prostatectomy and partial nephrectomy. Users’ perception was then evaluated with the Health Information Technology Usability Evaluation Scale (Health-ITUES) and the Face & Content validity questionnaire. Methods: The 3D virtual models, obtained from standard bi-dimensional imaging, were uploaded on a metaverse platform. Surgeons, thanks to dedicated visors, could plan their surgical strategy immersed in this virtual environment and discuss it with other attendees. Answers to the questionnaires were then evaluated and a stratification was subsequently performed based on surgical expertise, dividing participants in residents (Re), young urologists (YU) and senior urologists (SU). Results: Sixty-six participants filled out the questionnaires. As emerged from the Health-ITUES questionnaire, META_EXP covers an important role in the presurgical/surgical planning and decision-making process and appears to be useful for preoperative planning, with a median response of 4 and 5, respectively. Such results were also confirmed at the Face & Content validity questionnaire, with a median rate of 9/10 regarding its usefulness for surgical planning. Also, anatomical accuracy was positively rated regarding both organ’s and disease’s details, with a median response of 9. Conclusion: In conclusion, the metaverse experience for preoperative surgical planning appears to be useful, user-friendly and accurate. This technology has been widely appreciated by surgeons, irrespective of their experience.