V6-04: The SIMPortal Fluoro-less C-arm Trainer (CAT): an innovative training device for percutaneous kidney access

Video

Introductions and Objectives
Achieving proper renal access is a challenging component of the percutaneous nephrolithotomy (PCNL) procedure. Existing trainers include virtual reality (VR) simulators or physical simulator models requiring actual fluoroscopy and radiation exposure precautions. _x000D_ To fill this gap, we developed a physical fluoro-less C-arm for training percutaneous renal access.

Methods
The C-arm trainer is made of two main components: a mini C-arm for simulating fluoroscopic imaging and a silicon flank model for needle insertion.The new version presented in this video has an aluminium structure and is scaled to fit on a standard desk. It is provided with two video cameras connected via USB to an Apple Macbook ProTM for video processing. The images sent by the two webcams are overlaid using the "chroma key" transparency filter and software processed to achieve the final on-screen result.

Results
The SimPORTAL C-arm trainer was tested during a hands-on urological course held in Hemel Hempstead in 2013. A total of 14 urologists tested the training device.After a didactic lesson held by an expert, subjects performed the bull's eye technique on the CAT, using a 16ga needle. 18 of the 26 punctures (69,2%) successfully hit the provided stone in the calix._x000D_ 12 attendants (85,7%) considered the X-ray simulated image as an accurate representation of a real fluoroscopic image and all of them (100%) felt that avoiding radiation was important for training.

Conclusions
The novel double camera system, coupled to the processing software, were able to obtain visual information enough to accomplish correctly the training tasks, without expensive additional 3d motion tracking technologies. Our C-arm training system for percutaneous renal punctures demonstrated to be feasible and a valid low-cost alternative to Virtual Reality systems.

Funding: none