Abstract: PD41-07
Sources of Funding: Research reported in this abstract was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448, sub-award TL1TR000449, from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Additional support was provided by the Washington University in St. Louis Division of Urology.

Introduction

Every year more partial nephrectomies are performed as a surgical treatment for kidney cancer. However, this procedure remains technically challenging and no established practice model exists for partial nephrectomy training. We created silicone renal tumor models using 3D printed molds of a patient's kidney with a mass. In this study, we seek to validate these silicone models using multiple simulations with urologists of different training levels.

Methods

This study is ongoing and recruitment began in late October 2016. Medical students, urology residents, fellows, and attending surgeons are recruited to perform simulated partial nephrectomies on silicone renal tumor models. Four trials are performed with a da Vinci surgical robot on two different days. Operation specific metrics including renal artery clamp time and surgical margins are recorded for each trial. Validated measures of self-assessed operative demand (NASA TLX) and reviewer-assessed surgical performance (GEARS) are also recorded across trials.

Results

The preliminary results of two medical students, four urology residents, two endourology fellows, and one attending urologist are reported here. Between trials one and four we saw a mean reduction of 3.26 minutes in renal artery clamp time, and a 75% reduction in positive margins. We also saw reduced incidence of positive surgical margins with advanced training stage. Fellows, residents, and medical students had positive margin incidences of 25%, 50%, and 75% respectively. Model face validity was surveyed on a 0-100 sliding scale anchored at unrealistic and realistic. Mean results thus far are 77.5 for overall feel, 79 for needle driving, and 77.5 for cutting. We expect to recruit 20 additional subjects for this study. Upon completion of data acquisition, more robust statistical comparisons and measures will be reported.

Conclusions

Preliminary data indicate a trend in improved surgical performance over the course of the training and better performance in urologists of higher training levels. Face validity measures indicate the model adequately represents reality. This model may have potential for broader application and integration into minimally invasive surgery training programs.

Funding

Research reported in this abstract was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR000448, sub-award TL1TR000449, from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Additional support was provided by the Washington University in St. Louis Division of Urology.