V9-10: Simulated Inanimate Model for Physical Learning Experience (SIMPLE) for Robotic Partial Nephrectomy Using a 3-D Printed Kidney Model

Video

Introductions and Objectives
Live operative exposure remains the vanguard of surgical education. Surgical skills simulators have been successful in bridging gaps in training methods. In their current state however, they do not provide a complete operative experience. In this video we demonstrate a high fidelity, inexpensive, simulated inanimate model for physical learning experience in partial nephrectomy (SIMPLE-PN). Our realistic phantoms create a comprehensive operative experience that replicates all vital steps of a robot-assisted partial nephrectomy (RAPN) and permits measurement of procedure specific outcomes as metrics for assessment.

Methods
Using a novel method, anatomically correct models of the human kidney and relevant structures were created using poly-vinyl alcohol (PVA) hydrogels. These are achieved through graded polymerization of the hydrogel by inducing crosslinks during freeze/thaw (FT) cycles. This stiffens the phantom organs to the desired consistency one would experience during live surgery. All steps of RAPN were simulated. 3 experts with >250 robotic upper-tract cases were assigned to group 1, 3 novices with
Results
The model was determined to have good face and content validity with an average score of 3/5 and 4/5, respectively. Ischemia time remained 40 minutes in groups 1,2 and 3 respectively. A significant difference was demonstrated in overall operative time, ischemia time, and positive surgical margins and estimated blood loss (all values
Conclusions
SIMPLE provides a realistic, inexpensive, high fidelity model that offers comprehensive training for a RAPN. This form of simulation can be a useful surgical technique teaching tool, and allow objective trainee assessment. Validation for appearance and skill assessment was demonstrated using surveys and procedure specific metrics. This new model provides trainees adequate exposure to a simulated live environment to master skills necessary prior to a live operating room surgical experience.

Funding: University of Rochester Deans teaching fellowship.