Category: Education, Simulation & Virtual Reality

MP19-10 - The development of a patient-specific simulator for laparoscopic partial nephrectomy

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : Training systems that simulate surgical processes are commercially available. They are useful for basic training, but do not correspond to the specific characteristics of each patient. Therefore, we have developed a unique training system: a patient-specific simulator for laparoscopic surgery. Using specific data for each patient, this system enables surgeons to perform “rehearsal” operations under virtual reality conditions. We have already reported a nephrectomy model for use with this simulator. Now, we have developed a partial nephrectomy model.


Methods : Dynamic computed tomography scans of patients that were scheduled to undergo renal surgery were captured by the model data generation system. Patient-specific volume data for the kidneys, renal tumors, and the organs around the kidneys were extracted and entered into the simulator. In the simulator, the organs of each patient were reproduced. Thus, by creating simulations based on patient-specific data, surgeons are given an opportunity to perform preoperative “rehearsals”. We have used this approach for preoperative training in laparoscopic radical nephrectomy. Now, we can do the same for laparoscopic partial nephrectomy.


Results :

The simulator is programmed to adapt to laparoscopic and retroperitoneoscopic approaches. The scope and other trocars can be placed anywhere in the simulator.  It is possible to simulate the dissecting of renal vessels and the resecting of renal tumors. Tumor resection is performed using scissors and forceps. During tumor resection, the user can identify the renal cortex, medulla, and sinus fat. In addition, the interlobular arteries and renal calyx can be seen in the renal sinus fat. These structures are all simulated based on the patient’s data. The intrarenal arteries can be clipped, sealed, or coagulated before they are cut.
The simulator creates preoperative images of each patient’s anatomy, which is very useful, especially in cases involving complex anatomies. Furthermore, we can identify the optimal approach by comparing the transabdominal and retroperitoneal approaches. We can also determine the ideal trocar location before surgery. Finally, we can rehearse tumor resection again and again based on patients’ specific intrarenal structures.


Conclusions : A patient-specific simulator for laparoscopic partial nephrectomy has been successfully developed. As partial nephrectomy procedures differ from case to case, this simulator will be useful for patient-specific surgical planning and training and might improve the safety and accuracy of such surgery.

Kazuhide Makiyama

Associate Professor
Department of Urology, Yokohama City University Graduate School of Medicine
Yokohama, Kanagawa, Japan

Shinji Ohtake

graduate student
Department of Urology, Yokohama City University Graduate School of Medicine
Yokohama, Kanagawa, Japan

Azumi Araki

doctor
Department of Urology, Yokohama City University Graduate School of Medicine
Yokohama, Kanagawa, Japan

Ryousuke Jikuya

Yokohama, Kanagawa, Japan

Masahiro Yao

Professor
Department of Urology, Yokohama City University Graduate School of Medicine
Yokohama, Kanagawa, Japan

Yoshinobu Kubota

Yokohama, Kanagawa, Japan