V6-04: Full Immersion Simulated Percutaneous Nephrolithotomy Using 3D Printing Technology
The restriction of resident hours and an increasing focus on quality based hospital goals leads to inadequate training. Complex procedures such as the percutaneous nephrolithotomy (PCNL) have a steep learning curve and create an unsafe environment for patients when residents participate. In this video we demonstrate a high fidelity, inexpensive, simulated inanimate model for physical learning experience in a PCNL that allows a full immersion simulation including all aspects of the procedure.
Anatomically correct models of the human pelvicalyceal system, kidney and relevant adjacent structures were created using poly-vinyl alcohol (PVA) hydrogels. All steps of a PCNL were simulated including fluoroscopic access, nephroscopy, and lithotripsy. Both urologists and interventional radiologists (access only) attempted the procedure. Participants were considered experts if they completed more than 100 PNCL procedures. Face validity was calculated using only experts rating of the similarity of model to a real patient. Content validity was computed for all participants using questions about the usefulness of the model as a training tool. Construct validity was calculated by comparing procedural metrics.
The model was determined to have excellent face and content validity with an average score of 4.5/5.0 and 4.6/5.0, respectively. There were significant differences between novices and experts operative metrics including mean fluoroscopy time, number of percutaneous access attempts, number of times the needle was repositioned, and stone clearance (table 1). Complications such as inappropriate access into hilum or pelvicalyceal perforations were seen among trainee procedures.
We demonstrated a method to create a realistic and inexpensive full task trainer for a PCNL. All key steps of the procedure were shown and the model received excellent rating for realism on surveys. There was a significant difference in operative metrics between experts and novices, which permits the accurate assessment of performance. While operating on live patients under supervision will always remain a necessary task and the most effective method, our full immersion simulation provides a comparable comprehensive training tool.