Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA.
Department of Surgery, Transplant, University of Rochester Medical Center, Rochester, New York, USA.
J Endourol. 2020 Oct;34(10):1088-1094. doi: 10.1089/end.2020.0441. Epub 2020 Aug 28.
Despite the adoption of robotic donor nephrectomy, the steep learning curve of robotic recipient transplantation has hindered the implementation of a complete robot-assisted kidney transplantation (RAKT). We sought to develop a high-fidelity perfused full immersion nonbiohazardous platform for RAKT simulation training. A three-dimensional (3D) computer-aided design (CAD) model consisting of a kidney, pelvicaliceal system, renal artery, and vein was created from a CT scan of a donor patient. 3D printed casts designed from the CAD model were injected with various polyvinyl alcohol hydrogel formulations to fabricate an anatomical kidney phantom and surrounding abdominal cavity. The process was repeated using a recipient's CT scan to create the recipient pelvic model containing a bony pelvis, pelvic musculature, iliac arteries and veins, and bladder. Donor and recipient models each contained structures to simulate the perfused vascular and ureterovesical anastomosis. A board-certified transplant surgeon completed a robotic training curriculum, including four RAKT simulation procedures, from procurement of the donor kidney to final retroperitonealization. Metrics from the simulations (e.g., arterial, venous, ureterovesical, and total anastomosis times) were recorded and compared with surgical times from published data. The average time for the nephrectomies was 67.33 (±31.58) minutes. The average total anastomosis time was 60.85 (±9.73) minutes with 20.37 (±3.87), 20.17 (±4) and 15.1 (±2.35) minutes for arterial, venous, and ureterovesical anastomosis, respectively. The recorded arterial and venous anastomosis times were within published times for competency (Δ = 2.47 and Δ = 2.87, respectively), whereas the uterovesical time was within the mastery range (Δ = 0.45). Using a combination of 3D printing and hydrogel casting technologies, a high fidelity perfused full-immersion nonbiohazardous simulation platform for RAKT was developed. The utilization of this platform has the potential to replace the early cases in a learning curve while decreasing the barriers to utilization for transitioning transplant surgeons.
尽管已经采用了机器人供肾切除术，但机器人受体移植的陡峭学习曲线阻碍了完全机器人辅助肾移植（RAKT）的实施。我们试图开发一种高保真的灌注全浸入式非生物危害平台，用于 RAKT 模拟培训。 从供体患者的 CT 扫描创建了一个由肾脏、肾盂系统、肾动脉和静脉组成的三维（3D）计算机辅助设计（CAD）模型。根据 CAD 模型设计的 3D 打印铸件被注入各种聚乙烯醇水凝胶制剂中，以制造解剖肾脏模型和周围的腹腔。使用受体的 CT 扫描重复该过程，以创建包含骨盆骨骼、骨盆肌肉、髂动脉和静脉以及膀胱的受体骨盆模型。供体和受体模型均包含模拟灌注血管和输尿管-膀胱吻合术的结构。一名经过董事会认证的移植外科医生完成了机器人培训课程，包括四个 RAKT 模拟程序，从供体肾脏的获取到最终的腹膜后化。记录模拟的指标（例如，动脉、静脉、输尿管-膀胱和总吻合时间），并与已发表数据中的手术时间进行比较。 肾切除术的平均时间为 67.33（±31.58）分钟。总吻合时间的平均时间为 60.85（±9.73）分钟，动脉、静脉和输尿管-膀胱吻合的平均时间分别为 20.37（±3.87）、20.17（±4）和 15.1（±2.35）分钟。记录的动脉和静脉吻合时间在胜任力范围内（Δ=2.47 和 Δ=2.87），而输尿管-膀胱时间在掌握范围内（Δ=0.45）。 使用 3D 打印和水凝胶铸造技术的组合，开发了一种用于 RAKT 的高保真灌注全浸入式非生物危害模拟平台。该平台的使用有可能替代学习曲线中的早期病例，同时降低过渡移植外科医生使用的障碍。
