Work

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

Year: 2023

Type: article

Abstract: 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. To demonstrate a high fidelity and improved patient outcomes with hydrogel simulations for surgical rehearsals of a complex procedure (PCNL). Between 2016 and 2017 a single surgeon performed 18 consecutive PCNLs, 10 prospectively, at an academic referral center 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. Procedure specific metrics and patient outcomes were collected for all patients. 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. 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.

Source: Urology Video Journal

DOI: 10.1016/j.urolvj.2022.100203

Authors: Ahmed Ghazi, Nathan Schuler, Lauren Shepard, Tyler Holler, Patrick Saba, Jean Joseph

Institution: University of Rochester Medicine

Language: English

Topic: Surgical Simulation and Training

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $750