Abstract: PD41-01
Sources of Funding: none

Introduction

Surgical simulation is known to enhance technical skills and this effect is typically strongest for novices because complex procedures such as the PCNL have a steep learning curve. While the benefit of simulation is evident for cases when residents participate, it is unclear how preoperative rehearsal can impact patient safety in the hands of experienced practitioners. We present our initial experience using a high fidelity 3D printed simulation for surgical rehearsal in patients undergoing a PCNL.

Methods

A total of 15 consecutive patients underwent PCNL by a single Urologist. Before the live procedure, 7 patient specific simulations were performed for preoperative rehearsal. These models were created by converting DICOM images into stereolithography files and 3D printing components for assembly. In addition to the patient&[prime]s pelvicalyceal system and staghorn calculi, their kidney, spine, and posterior abdominal wall were also fabricated to create a complete procedural simulation. All steps of a PCNL were practiced including fluoroscopic access, nephroscopy, and lithotripsy. Procedure specific metrics such as radiation time and number of needle attempts were collected for live and simulation events. Outcomes from the first 8 patients without prior rehearsal were compared to the next 7 patients with preoperative practice.

Results

The mean fluoroscopy time was significantly lower in the rehearsal group (6.2 vs 12.7 mins, p = 0.03). The average combined time of fluoroscopy for simulation and live cases was still lower than the mean time for unrehearsed group (10.2 vs 12.7 mins, p = 0.22). Similarly, the average number of percutaneous needle access attempts was lower in the rehearsed group (1.8 vs 5 attempts, p < 0.001). The total number of complications and additional procedures was higher in the unrehearsed group (5 vs 1 and 9 vs 1, respectively). There were no differences in mean patient age, body mass index, or stone size between the two groups.

Conclusions

This study demonstrated that patient specific rehearsal improved surgeon performance for a complex endourological procedure. There was a significant reduction in fluoroscopy time, percutaneous needle access attempts, additional procedures and complications, with an improved stone clearance rate. There was no significant increase in radiation dose to the surgeon despite rehearsal. Advances in 3D printing technology permit it&[prime]s routine use for simulation of complicated operations and possess the ability to directly impact patient outcomes.

Funding

none