Nuley Seo1, Bader Alsaikhan2,3, Bruce Gao4,5, Melody Djuimo2,6, Sylvia Koo7,8, Shahob Hosseinpour2,9, Brian Carrillo10, Monica Farcas2,11,12. 1. University of Toronto Temerty Faculty of Medicine, 12366, Toronto, Ontario, Canada; nseo@u.rochester.edu. 2. University of Toronto Temerty Faculty of Medicine, 12366, Toronto, Ontario, Canada. 3. St Michael's Hospital, 10071, Division of Urology, Toronto, Ontario, Canada; saikhan.md@gmail.com. 4. University of Toronto Temerty Faculty of Medicine, 12366, Urology, Toronto, Ontario, Canada. 5. St Michael's Hospital, 10071, Division of Urology, Toronto, Ontario, Canada; Bruce.Gao@one-mail.on.ca. 6. St Michael's Hospital, 10071, Division of Urology, Toronto, Ontario, Canada; suzymelody.djuimo@me.com. 7. University of Hawai'i at Mānoa John A Burns School of Medicine, 50677, Honolulu, Hawaii, United States. 8. St Michael's Hospital, 10071, Division of Urology, Toronto, Ontario, Canada; sylviask@hawaii.edu. 9. University of Toronto Temerty Faculty of Medicine, 12366, Department of Radiology, Toronto, Ontario, Canada; shahob.hosseinpour@mail.utoronto.ca. 10. Toronto, Canada; carrillo.b@gmail.com. 11. St Michael's Hospital, 10071, Department of Surgery, Division of Urology, Toronto, Ontario, Canada. 12. St Michael's Hospital Li Ka Shing Knowledge Institute, 518773, Toronto, Ontario, Canada; Monica.Farcas@unityhealth.to.
Abstract
INTRODUCTION: Flexible ureteroscopy (fURS) is a one-person surgical technique, limiting trainees' ability to practice intra-operatively. Although well-suited for simulation training, few existing fURS simulators reproduce accurate, complex renal collecting system anatomies. We developed an anatomically accurate fURS simulator using 3D reconstructions of CT urograms and 3D printing technology to address this need. METHODS: Patient-specific CT urograms were used to create 3D reconstructions of the renal collecting system using SlicerTM. 3D models were modified using BlenderTM. Hollow elastomer kidney models were created using an Objet 3DTM printer. To test and evaluate the new fURS simulator, 25 volunteers were recruited (5 novices, 13 residents, 7 urologists). Participants were asked to explore the model with fURS and were evaluated on their ability to deduce its 3D anatomy, their ability to navigate to prespecified calyces, and their time to task completion. Furthermore, participants were asked to compare the anatomical model to existing fURS benchtop models (Cook MedicalTM and Limb and ThingsTM) on several criteria, including internal visualization; tactile feedback; and overall functional and teaching fidelity, in a survey. RESULTS: We were able to create a fURS simulator that accurately replicates anatomically complex renal collecting systems. In exploring the model, we noted that unlike staff urologists, novices and residents often completely missed lower pole calyces. A survey comparison between our simulator and comparable benchtop simulators revealed consistently better ratings of our simulator on all criteria (p < 0.05). CONCLUSION: We were able to successfully create an anatomically accurate fURS simulator that provides a more realistic scoping experience. Preliminary testing revealed that trainees will benefit from this simulator particularly with respect to learning how to navigate challenging collecting systems.
INTRODUCTION: Flexible ureteroscopy (fURS) is a one-person surgical technique, limiting trainees' ability to practice intra-operatively. Although well-suited for simulation training, few existing fURS simulators reproduce accurate, complex renal collecting system anatomies. We developed an anatomically accurate fURS simulator using 3D reconstructions of CT urograms and 3D printing technology to address this need. METHODS:Patient-specific CT urograms were used to create 3D reconstructions of the renal collecting system using SlicerTM. 3D models were modified using BlenderTM. Hollow elastomer kidney models were created using an Objet 3DTM printer. To test and evaluate the new fURS simulator, 25 volunteers were recruited (5 novices, 13 residents, 7 urologists). Participants were asked to explore the model with fURS and were evaluated on their ability to deduce its 3D anatomy, their ability to navigate to prespecified calyces, and their time to task completion. Furthermore, participants were asked to compare the anatomical model to existing fURS benchtop models (Cook MedicalTM and Limb and ThingsTM) on several criteria, including internal visualization; tactile feedback; and overall functional and teaching fidelity, in a survey. RESULTS: We were able to create a fURS simulator that accurately replicates anatomically complex renal collecting systems. In exploring the model, we noted that unlike staff urologists, novices and residents often completely missed lower pole calyces. A survey comparison between our simulator and comparable benchtop simulators revealed consistently better ratings of our simulator on all criteria (p < 0.05). CONCLUSION: We were able to successfully create an anatomically accurate fURS simulator that provides a more realistic scoping experience. Preliminary testing revealed that trainees will benefit from this simulator particularly with respect to learning how to navigate challenging collecting systems.
Authors: E Checcucci; D Amparore; G Volpi; F Piramide; S De Cillis; A Piana; P Alessio; P Verri; S Piscitello; B Carbonaro; J Meziere; D Zamengo; A Tsaturyan; G Cacciamani; Juan Gomez Rivas; S De Luca; M Manfredi; C Fiori; E Liatsikos; F Porpiglia Journal: World J Urol Date: 2021-09-01 Impact factor: 3.661