A New Model with an Anatomically Accurate Human Renal Collecting System for Training in Fluoroscopy-Guided Percutaneous Nephrolithotomy Access

Abstract

Background and Purpose: Obtaining renal access is one of the most important and complex steps in learning percutaneous nephrolithotomy (PCNL). Ideally, this skill should be practiced outside the operating room. There is a need for anatomically accurate and cheap models for simulated training. The objective was to develop a costeffective, anatomically accurate, nonbiologic training model for simulated PCNL access under fluoroscopic guidance. Methods: Collecting systems from routine computed tomography urograms were extracted and reformatted using specialized software. These images were printed in a water-soluble plastic on a three-dimensional (3D) printer to create biomodels. These models were embedded in silicone and then the models were dissolved in water to leave a hollow collecting system within a silicone model. These PCNL models were filled with contrast medium and sealed. A layer of dense foam acted as a spacer to replicate the tissues between skin and kidney. Results: 3D printed models of human collecting systems are a useful adjunct in planning PCNL access. The PCNL access training model is relatively low cost and reproduces the anatomy of the renal collecting system faithfully. A range of models reflecting the variety and complexity of human collecting systems can be reproduced. The fluoroscopic triangulation process needed to target the calix of choice can be practiced successfully in this model. Conclusions: This silicone PCNL training model accurately replicates the anatomic architecture and orientation of the human renal collecting system. It provides a safe, clean, and effective model for training in accurate fluoroscopy-guided PCNL access.

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“…Software and hardware require the largest investment, altogether totaling from $13,000 to $40,000. 33,51 It is important to bear this in mind, as heavy initial investment may not be viable in healthcare systems of less well-developed countries.…”

“…51 The models also removed the need for animal training models, which were not reliably representing human anatomy, thus improving the ethical standpoint as well. Although start-up costs can be high, the cost of individual unit production is relatively low.…”

“…These range from $0.50 for a model ear, to $100 for a model of renal M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT pelvicalyceal anatomy to $1000 for a life-size pelvis. 10,46,51 It must be considered that as time passes the costs of the technology would decrease. 11 The timescales involved for the production of 3D printed models is variable, dependent on the method used to print the object, as well as its size and complexity.…”

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“…However, some other investigators have doubted efficiency and price of RP [113]. 3D printed replicas are considered to be more precise and cost-effective for patients and trainee education compared to other techniques [114]. This method also eliminates the need for animal studies [64].…”

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“…To overcome this obstacle, several attempts were made by creations of stereo-lithographic 4 biomodel, using laser and 3D printing of the PCS (Radecka et al 2006) (Turney 2014).…”