Development of a High-Fidelity Robotic Assisted Kidney Transplant (RAKT) Simulation Platform using 3D Printing and Hydrogel Casting Technologies.

2020 
INTRODUCTION AND OBJECTIVE Despite the adoption of robotic donor nephrectomy, the steep learning curve of robotic recipient transplantation has hindered the implementation of a complete robotic assisted kidney transplantation (RAKT). We sought to develop a high-fidelity, perfused, full immersion, non-biohazardous platform for RAKT simulation training. METHODS A three-dimensional (3D) computer aided design (CAD) model consisting of a kidney, pelvicalyceal 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 to surgical times from published data. RESULTS 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) while the uterovesical time was within the mastery range (Δ=0.45). CONCLUSIONS Using a combination of 3D printing and hydrogel casting technologies, a high fidelity, perfused, full-immersion, non-biohazardous 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.
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