A novel 3D-printed hybrid simulation model for robotic-assisted kidney transplantation (RAKT)

Abstract

Robotic-assisted kidney transplantation (RAKT) offers key benefits for patients that have been demonstrated in several studies. A barrier to the wider uptake of RAKT is surgical skill acquisition. This is exacerbated by the challenges of modern surgery with reduced surgical training time, patient safety concerns and financial pressures. Simulation is a well-established method of developing surgical skill in a safe and controlled environment away from the patient. We have developed a 3D printed simulation model for the key step of the kidney transplant operation which is the vascular anastomosis. The model is anatomically accurate, based on the CT scans of patients and it incorporates deceased donor vascular tissue. Crucially, it was developed to be used in the robotic operating theatre with the operating robot to enhance its fidelity. It is portable and relatively inexpensive when compared with other forms of simulation such as virtual reality or animal lab training. It thus has the potential of being more accessible as a training tool for the safe acquisition of RAKT specific skills. We demonstrate this model here.

The Creation of a Novel Low-Cost Bench-Top Kidney Transplant Surgery Simulator and a Survey on Its Fidelity and Educational Utility

“…Although 3D-printed simulators replicating the iliac fossa and kidney transplant allograft have been described in the practice of open or robotic vascular anastomoses of kidney transplants, their higher cosmetic fidelity likely offers little educational advantages compared to our bench-top simulator, as mimicking the critical steps of a procedure rather than fidelity level is most important in skill acquisition [9,15,16]. Moreover, creating a high cosmetic fidelity replicate of the iliac fossa and allograft costs approximately $1,000 more without added education benefits such as obtaining exposure, placing retractors, or dissection [15]. As opposed to the easy assembly of our bench-top simulator, the production of a 3Dprinted simulator requires approximately seven days of labor and technical expertise for imaging reconstruction from thin-cut CT imaging, working the printer, and choosing adequate ink [16].…”

“…As opposed to the easy assembly of our bench-top simulator, the production of a 3Dprinted simulator requires approximately seven days of labor and technical expertise for imaging reconstruction from thin-cut CT imaging, working the printer, and choosing adequate ink [16]. A 3D-printed 'hybrid' simulator has also been described using expired deceased donor iliac vessels instead of synthetic material to simulate vascular anastomosis [15]. Although more realistic, the disadvantages of expired deceased donor iliac vessels include a limited supply and the risk of infection transmission despite testing.…”

“…Individual transplant centers have developed local pig or deceased human body wet labs for residents to learn kidney transplant [3,13,14]. Experimental three-dimensionally (3D)-printed designs of a recipient iliac fossa and kidney transplant allograft with synthetic or donor-derived iliac vessels have also been created for practicing vascular anastomosis steps of open or robotic kidney transplants [15,16]. Future validation of these kidney transplant surgery simulation options for resident education will likely be difficult due to their high cost and lack of widespread availability.…”

Innovation in Urology: Three Dimensional Printing and Its Clinical Application

“…Experts and trainees rated the simulation superior to digital virtual reality (VR) trainers and experts performed better than residents in the simulation. Uwechue developed a 3D-printed simulation model for vascular anastomosis during robot-assisted kidney transplant, highlighting potential training value even amongst experienced surgeons when learning new surgical techniques (33). Pinto reported an observed improvement in residents microsurgical suture time and quality on a vasectomy reversal model produced via 3D-printing (41).…”

From digital world to real life: a robotic approach to the esophagogastric junction with a 3D printed model

“…In recent years, the rise of robot-assisted surgery for a variety of surgical procedures has significantly reshaped surgical practice [3–5], although the safety of the patient remains essential. The robotic platform enables surgeons to operate more accurately during difficult procedures compared to conventional laparoscopy, which provides high resolution three-dimensional (3D) operative views and improves depth perception, as well as superior instrument handling [6, 7]. 3D printing, in addition to the standard medical imaging, may represent an invaluable tool to allow a good representation of surgical scenario, particularly in challenging cases [8].…”