Education, Simulation & Virtual Reality

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 241

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

Kazuhide Makiyama

Gender: Male Date of Birth: March 23, 1970 Citizenship: Japan
Business Address:
Yokohama City University
3-9 Fukuura Kanazawa-ku
Yokohama 236-0004, Japan
Phone: +81-45-787-2679
Fax: +81-45-786-5775
E-mail: makiya@yokohama-cu.ac.jp

Education:
2002 Doctor of Medical Science, Yokohama City University
1994 M.D. Faculty of Medicine, Yokohama City University

Training:
1994-1996 Resident, Yokohama City University

Appointments:
2009-present Associate Professor, Department of Urology, Yokohama City University
2002-2009 Assistant Professor, Department of Urology, Yokohama City University
2001-2002 Assistant Professor, Department of Urology, Tokyo Woman’s Medical University
2000-2001 Medical staff in Urology, Yokohama City Unversity Medical Center
1998-2000 Medical staff in Urology, Chigasaki Municipal Hospital
1996-1998 Medical staff in Urology, Yokohama Minami Kyosai Hospital

Scientific Activity:
Member of Japanese Urological Association
Member of Japanese Society of Endourology
Member of Japanese Society for Endoscopic Surgery
Member of Japan Society of Clinical Oncology
Member of The Japan Society for Transplantation
Member of Japanese Society for Clinical Renal Transplantation
Member of The Japanese Society for Dialysis Therapy
Member of American Urological Association

Laparoscopic and Robotic surgery
Adrenalectomy: 270 cases since 2002
Nephrectomy: 900 cases since 2002
Partial nephrectomy: 300 cases since 2002
Pyeloplasty: 100 cases since 2004
Prostatectomy: 300 cases since 2012
Cystectomy: 80 cases since 2008

Presentation(s):

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    Shinji Ohtake

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

    Presentation(s):

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      Azumi Araki

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

      Azumi Araki, M.D. ,Clinical Fellow, Department of Urology, Yokohama City University

      Licensure and Certification:
      National Board of Medicine
      Japanese Board of Urology

      Education:
      2009 Yokohama City University, Medical school

      Employment:
      2009-2010 Intern, Yokohama Minami Kyousai Hospital
      2010-2011 Intern, Yokohama City University Hospital
      2011-2012 Clinical Fellow, Yokohama Minami Kyousai Hospital, Urology
      2012-2013 Clinical Fellow, Kanagawa Prefectural Ashigarakami Hospital, Urology
      2013-2014 Clinical Fellow, Yokohama Sakae Kyosai hospital, Urology
      2014-2016 Clinical Fellow n, Yokohama Municipal Citizen’s Hospital, Urology
      2016- Clinical Fellow, Yokohama City University Hospital

      Presentation(s):

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        Ryousuke Jikuya

        Presentation(s):

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          Masahiro Yao

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

          Presentation(s):

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            Yoshinobu Kubota

            Presentation(s):

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