How specific are patient-specific simulations? Analyzing the accuracy of 3D-printing and modeling to create patient-specific rehearsals for complex urological procedures.

Abstract

In the field of urology, 3D printing and modeling are now regularly utilized to enhance pre-operative planning, surgical training, patient-specific rehearsals (PSR), and patient education and counseling. Widespread accessibility and affordability of such technologies necessitates development of quality control measures to confirm the anatomical accuracy of these tools. Herein, we present three methods utilized to evaluate the anatomical accuracy of hydrogel PSR, developed using 3D printing and molding for pre-operative surgical rehearsals, of robotic-assisted partial nephrectomy (RAPN) and percutaneous nephrolithotomy (PCNL). Virtual computer-aided designs (CADs) of patient anatomy were created through segmentation of patient CT scan images. Ten patient-specific RAPN and PCNL hydrogel models were CT scanned and segmented to create a corresponding model CAD. The part compare tool (3-matic, Materialize), point-to-point measurements, and Dice similarity coefficient (DSC) analyzed surface geometry, alignment, and volumetric overlap of each model component. Geometries of the RAPN parenchyma, tumor, artery, vein, and pelvicalyceal system lay within an average deviation of 2.5mm (DSC = 0.70) of the original patient geometry and 5mm (DSC = 0.45) of the original patient alignment. Similarly, geometries of the PCNL pelvicalyceal system and stone lay within 2.5mm (DSC = 0.6) and within 15mm (16% deviation) in alignment. This process enabled the refinement of our modeling process to fabricate anatomically accurate RAPN and PCNL PSR. As 3D printing and modeling continues to have a greater impact on patient care, confirming anatomical accuracy should be introduced as a quality control measure prior to use for patient care.