Virtual reality-enabled precision in percutaneous nephrolithotomy - strategic access planning in a malrotated kidney: A case report

Figure 1 Multimodal imaging and virtual reality–guided planning of percutaneous nephrolithotomy in a malrotated kidney. A: Contrast-enhanced computed tomography coronal image demonstrating a malrotated right kidney with an anterolaterally oriented renal hilum and a hyperdense renal pelvic calculus; B: Three-dimensional reconstruction generated from computed tomography DICOM data illustrating patient-specific renal anatomy, including the malrotated kidney, renal vasculature, and surrounding skeletal landmarks; C: Virtual reality–based immersive visualization used for preoperative planning, enabling identification of the posterior lower calyx and simulation of the planned posterior lower calyceal subcostal access tract; D: Intraoperative fluoroscopic image confirming successful posterior lower calyceal puncture corresponding to the preoperatively planned virtual reality trajectory.