Design of a non-biohazardous perfused simulation model for transurethral resection of bladder tumor (TURBT) using 3D printing and hydrogel casting

Abstract

Background: To develop a bleeding simulator for transurethral resection of bladder tumors (TURBT) and evaluate its use as a training tool. Methods: Anatomical models of the human bladder and relevant structures were created with poly-vinyl alcohol hydrogels using 3D printed molds. Mucosal, muscular, and perivesical fat layers were created in bladder model that contained 3 tumors of varying size, location and depth of invasion. Participants (n=14) who performed the TURBT simulation were designated as expert or novice based on prior caseload (> 50 TURBT cases). Using surveys, ratings of realism and usefulness of the model as a training tool were calculated. Ability to differentiate between levels of experience was demonstrated by comparison of procedural metrics (operative time, tumor margins, missed tumors, and perforations) between the groups. Results: The model was determined to have good realism and educational effectiveness, both with average scores of 4/5. The simulator was able to differentiate between the skills of novice and expert in several operative metrics including total resection time (p = 0.005), vascular tumor perforation rate (p = 0.01), and anterior tumor missed rate (p = 0.03). Non-statistically significant differences were seen in complete tumor resection, adequate muscle sampling, and complication rate. Conclusion: This perfused 3D printed hydrogel TURBT simulator demonstrated adequate realism education effectiveness and ability to differentiate between skill levels. Incorporating full procedural simulation may have the potential to enhance training, encourage maintenance of procedural skills, and provide a method for technical assessment.

Keywords

• TURBT
• 3D printing
• Simulation
• Surgical training
• Bladder tumor