To compare remotely to in-person training during image-guided percutaneous nephrolithotomy (PCNL), we used mixed reality (MR), smart glasses, and a validated hydrogel simulation model to test surgical education uptake with urological residents.

Twelve urology residents were randomized into 2 learning groups (MR-first or in-person-first) and completed a pre-test, MR or IP-guided training sessions, mid test, cross-over into MP or IP-guided training, post-test, and a retention test 2 months post-training to evaluate upper and lower pole access and balloon dilatation. MR sessions utilized Vuzix smart glasses and HelpLightning MR software to allow the instructor to remotely instruct the student and share their first-person perspective. Performance was assessed against a checklist of metrics including attempts for access, procedure time, and a model specific checklist. Learner perspectives were assessed after each training session using 5-point Likert scales and open form comments.

Overall attempt scores improved significantly for lower pole and upper pole procedures from pre- to mid-test and pre- to post-test (LP: 50% vs 74.5%, P=.0019, 50% vs 82.8%, P=.001; UP: 43.6% vs 63.75%, P=.0002; 43.6% vs 70.5%, P=3.6e-05) in both MR and IP cohorts. Learner evaluations suggested that the majority still prefer IP instruction, citing technological difficulties.

MR-based remote learning is equally effective when compared to in-person instruction of US-PCNL.