Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies

Abstract

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 robot-assisted kidney transplantation (RAKT). We sought to develop a high-fidelity perfused full immersion nonbiohazardous platform for RAKT simulation training. Methods: A three-dimensional (3D) computer-aided design (CAD) model consisting of a kidney, pelvicaliceal 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 with 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 (D = 2.47 and D = 2.87, respectively), whereas the uterovesical time was within the mastery range (D = 0.45). Conclusions: Using a combination of 3D printing and hydrogel casting technologies, a high fidelity perfused full-immersion nonbiohazardous 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.

A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education

“…Rochester has refined a method for producing computer-generated printed organ models using printed moulds and polyvinyl alcohol (PVA) hydrogel and have already validated some of these models. Realistic models for simulation of robot-assisted kidney transplant [ 62 ] (Fig. 5 ), robot-assisted partial nephrectomy (Fig.…”

“…These models have a high degree of anatomical and functional realism, including simulated blood flow, cautery and realistic suturability properties [ 65 ]. Saba et al’s (2020) kidney transplant model was produced using combined 3D-printing and hydrogel casting technologies [ 62 ]. The validity of this model was limited to a single surgeon single centre study.…”

“…5 Robot-assisted kidney transplant model. Source: Saba et al (2020) [ 62 ]

Fig. 6 Robot-assisted partial nephrectomy hydrogel model.

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Robot‐assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end‐stage renal disease

“…No significant differences in gender or kidney donor profile index were observed between groups (p = 0.149 and p = 0.72, respectively). The RAKT and OKT groups had a median pretransplant BMI of 38.54 (range, 35-44) and 40.1 (range, [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] kg/m 2 , respectively (p = 0.08). Most patients were dialysis dependent before transplant (95.8%), with mean dialysis duration of 50.7 and 48.1 months, respectively (p = 0.81).…”

“…[29][30][31][32][33] The advantages provided by RAKT potentially include smaller incisions, better visibility during the anastomosis in morbidly obese patients, less tissue manipulation/exposure, and faster recovery. 34,35 This study evaluates these outcomes in the first series of RAKTs in morbidly obese patients at the new robotic transplant surgery centre at the University of Virginia (UVA).…”