Validity of a Patient-Specific Percutaneous Nephrolithotomy (PCNL) Simulated Surgical Rehearsal Platform: Impact on Patient and Surgical Outcomes

Abstract

Background: The benefits of surgical simulation have been previously demonstrated to enhance technical skills resulting in improved outcomes. Complex procedures such as the percutaneous nephrolithotomy (PCNL) have a steep learning curve and have the potential to create an unsafe patient environment. Objective: To demonstrate a high fidelity and improved patient outcomes with hydrogel simulations for surgical rehearsals of a complex procedure (PCNL). Design, Setting, Participants: Between 2016 and 2017 a single surgeon performed 18 consecutive PCNLs, 10 prospectively, at an academic referral center Intervention: Anatomically correct models of the human pelvicalyceal system, kidney and relevant adjacent structures were created using poly-vinyl alcohol (PVA) hydrogels of the 10 prospective patients. DICOM images were converted to computer assisted designs and a patient specific model were created using 3-Dimensional printing and biomaterials technology. All PCNL steps were simulated: fluoroscopic access, nephroscopy, and lithotripsy. After surgical rehearsal the following day PCNL was performed by the trainee. Outcome Measurements and Statistical Analysis: Procedure specific metrics and patient outcomes were collected for all patients. Results and Limitations: There were significant differences in operative metrics (mean fluoroscopy time, the number of percutaneous access attempts, the number of times the needle was repositioned, and stone clearance) and patient outcomes (complications, length of stay and readmission rates). The study is limited by the sample size. Conclusions: This study demonstrates that patient-specific procedural rehearsal is effective for enhancement in the performance of a complex endourological procedure through the reduction in total operative and fluoroscopy times with improvement in patient outcomes. By incorporating this technology, medical practice would be following the route of other high-stakes industries in utilizing simulation to minimize complications for patients undergoing standard and more complex procedures and improving overall patient safety.

Keywords

• PCNL
• 3D printing
• Simulation
• Surgical training
• Patient Specific