Authors: Kyla Velaer, Palo Alto , CA, Jose Vargas, Palo Alto, CA, Kunj Sheth, Palo Alto , CAIntroduction: Due to the lower volume of pediatric robotic surgeries, urology residents have limited opportunities to master techniques for a robotic pyeloplasty. To bridge the gap, we aim to develop various pediatric ureteropelvic junction obstruction (UPJO) simulation models using the advantages of rapid prototyping for new molding techniques to accurately simulate pediatric tissue.
Methods: Surgical simulation models for four different UPJO pathologies (standard UPJO with extra renal pelvis, long proximal ureteral stricture, high ureteral insertion, small intrarenal pelvis) were successfully manufactured through a collaborative effort between two urologists and a mechanical engineer. We developed a unique patented manufacturing system using molds to configure the silicone casting into an accurate representation of UPJ tissues. Intricately designed combined renal pelvis and ureter units are inserted into a modular kidney, to anchor them to the simulation stand. We used a previously validated 5 point, 11-item tissue-likeness scale to evaluate the models.
Results: Two attending urologists, one robotic surgery fellow, and two senior urology residents independently tested each model. Overall, the users noted accurate representation of the various UPJ obstructions and reported that the silicone accurately represented pediatric tissue and could handle surgical manipulation. The standard UPJO, high insertion, long proximal ureteral stricture model performed similarly with average score of 4.8 in its similarity to human anatomy and tissue manipulation. The small intrarenal pelvis also performed well with an average score of 4.6 for accurate anatomic representation. The users reported subjective improvement in skills after testing the models with an average score of 4.25. None of the surveyed urologists reported problems with tissue manipulation.
Conclusions: The UPJO surgical simulation models developed using our patented manufacturing technique show excellent tissue-likeness on initial evaluation. Further user testing of the models is necessary to evaluate improvement in surgical skill level.
Source of Funding: Stanford Department Funds