TECHNICAL FIELD

Various aspects of the present disclosure relate generally to systems and methods useful in planning and/or performing medical procedures.

BACKGROUND

Substantial progress has been made towards increasing the effectiveness of medical treatment while reducing trauma and risks to the patient. Many procedures that once required open surgery now may be done with less invasive techniques that limit the size of incision, thus providing for less recovery time and risks of infection for the patient. Certain procedures requiring biopsy, electro-stimulation, tissue ablation, or removal of native or foreign bodies may be performed through minimally-invasive surgery.

In the field of urology, for example, renal calculi or kidney stones can accumulate in the urinary tract and become lodged in the kidney. Kidney stones are deposits of materials from the urine, typically minerals and acid salts. While smaller stones may pass from the body naturally, larger stones can require surgical intervention for removal. While open surgery was once the standard treatment for the removal of stones, other less invasive techniques, such as ureteroscopy and percutaneous nephrolithotomy/nephrolithotripsy (PCNL), have emerged as safer, effective alternatives. Yet, procedures such as PCNL still carry risks.

Minimally-invasive procedures like PCNL offer benefits in patient recovery, but afford the physician only a limited view of the treatment site. As a result, it may be difficult to gain sufficient access to a targeted site without causing collateral injury to the patient. Without sufficient knowledge of the patient's anatomy, a physician may need several attempts to properly position and orient the instruments to remove the stone. If the stone is larger or more difficult to grasp than expected for the first route of access, a secondary route of access may be necessary. Repeated attempts at access increase the risk of collateral injury to blood vessels, surrounding tissue, and neighboring organs, and can increase the likelihood of hemorrhage, infection, and fluid leakage/sepsis.

Medical personnel who do not routinely perform PCNL procedures may be especially anxious at the possibility of injury due to improper triangulation to the stone. While patient images like computer tomography (CT) scans may be available for reference beforehand, they often are obtained weeks or months before the PCNL procedure. The stone may have grown in size and/or changed position during the interim, thus adding further uncertainty to successfully removing the stone with minimal harm to the patient.

SUMMARY

The present disclosure includes a method for determining a patient-specific surgical access plan for a medical procedure using at least one computer system, the method comprising receiving over an electronic network, at the at least one computer system, one or more radiographic images of an anatomical structure of a patient; generating a display of the one or more radiographic images; generating at least one request for user input to identify features of the anatomical structure in the one or more radiographic images; receiving a first user input identifying the features of the anatomical structure; identifying, by the at least one computer system, at least one access plan for performing the medical procedure based on the received user input; and generating a display of the identified at least one access plan associated with the one or more radiographic images. In some examples, the medical procedure may be percutaneous nephrolithotomy or percutaneous nephrolithotripsy, and the anatomical structure may be a kidney.

According to some aspects, the one or more radiographic images may include images obtained by computer tomography. The display may include, for example, a three-dimensional representation of the anatomical structure, which may be reconstructed from computer tomography and/or other imaging methods. The radiographic image(s) need not be obtained by computer tomography, or may include additional images obtained by imaging techniques other than computer tomography.

The method may further comprise one or more additional steps. For example, the method may further comprise modifying the one or more radiographic images based on the first user input. Modifying the one or more radiographic images may include, for example, comparing the one or more radiographic images to reference patient data for the medical procedure. Additionally or alternatively, the method may comprise manually and/or automatically identifying one or more features of the anatomical structure in the one or more radiographic images before generating the at least one request for user input.

In some examples, generating the at least one request for user input includes asking a user to identify and/or confirm a location of a kidney stone in the one or more radiographic images. Further, for example, the method may include calculating, by the at least one computer system, at least one characteristic of the kidney stone based on the radiographic image(s). According to some aspects, the characteristic(s) may be chosen from stone burden, stone density, skin to kidney capsule distance, skin to kidney stone distance, or a combination thereof. Other characteristics of the kidney stone may be calculated, identified, or otherwise determined. Identifying the at least one access plan may include calculating a needle trajectory based on the calculated at least one characteristics of the kidney stone.

According to some aspects, the method may comprise generating a patient template that indicates one or more sites (e.g., insertion site(s) for inserting a needle) according to the identified access plan(s). The access plan(s) may include a location and a depth for inserting a needle at the insertion site, e.g., such that the access plan(s) identify a suitable position for the needle to access the patient's anatomy for performing the medical procedure. Generating the patient template may include, for example, printing one or more markings identifying the insertion site to a sheet or other material suitable for transfer to a patient prior to the medical procedure. For example, generating the patient template may include printing at least a first marking identifying the insertion site according to the access plan and a second marking providing a reference relative to one or more anatomical features of the patient. Additionally or alternatively, the at least one access plan may include information on a trajectory of the needle for insertion at the insertion site.

According to some aspects of the present disclosure, the method may comprise performing the medical procedure by inserting a needle at an insertion site according to the at least one access plan. The insertion site may be identified by a light source, e.g., a laser light source or other light source of an imaging device, which may be directed towards the skin of the patient. The light source may be in communication with the electronic network.

