Design and Validation of a Novel 3D-Printed Retrograde Intrarenal Surgery Trainer

Abstract

ObjectivesTo report on the design of a novel 3D-printed retrograde intrarenal surgery (RIRS) benchtop trainer and detail its validation against real-life experiences. MethodsDigital Imaging and Communications in Medicine (DICOM) files of two patients with normal computed tomography of the kidney and bladder were converted into stereolithography files to create 3D triangular mesh models. These images were further refined using Autodesk Meshmixer. These 3D models were fabricated through additive manufacturing, a process commonly known as 3D printing and assembled in a polypropylene case. After development, the model was validated by 40 experienced urologists and urology residents in their final year of training. They were asked to rate the components of the simulation using a nine-point questionnaire. ResultsThe model’s value in understanding the principles of RIRS and simulating contextual anatomy had mean scores of 9.43 (standard deviation [SD] = 0.74) and 9.21 (SD = 1.03), respectively. Mean scores for specific steps in RIRS were 8.07 (SD 1.47) for cannulating the ureteric orifice, 8.61 (SD 1.24) for inserting the ureteric access sheath, 9.29 (SD 0.97) for performing a renoscopy and evaluating all the calyces, 9.46 (SD 0.87) for laser lithotripsy, and 9.17 (SD 0.94) for manual stone retrieval. Participants scored the model with a mean score of 9.04 (SD 0.87) regarding realism and a mean score of 9.18 (SD 0.89) when evaluating its ability to enhance a trainee’s confidence in RIRS. ConclusionsThe model performed well for all components of RIRS. This model allows high fidelity of the simulation, and is cost-effective, portable, durable, reusable, and compatible with standard ureteroscopes.