Validity of a patient-specific percutaneous nephrolithotomy (PCNL) simulated surgical rehearsal platform: impact on patient and surgical outcomes.

Abstract

Simulators provide a safe method for improving surgical skills without the associated patient risks. Advances in rapid prototyping technology have permitted the reconstruction of patient imaging into patient-specific surgical simulations that require advanced expertise, potentially continuing the learning curve. To evaluate the impact of preoperative high-fidelity patient-specific percutaneous nephrolithotomy hydrogel simulations on surgical and patient outcomes. Between 2016 and 2017, a fellowship-trained endourologist performed 20 consecutive percutaneous nephrolithotomy procedures at an academic referral center. For the first ten patients, only standard review of patient imaging was completed. For the next ten patients, patient imaging was utilized to fabricate patient-specific models including pelvicalyceal system, kidney, stone, and relevant adjacent structures from hydrogel. The models were tested to confirm anatomic accuracy and material properties similar to live tissue. Full procedural rehearsals were completed 24-48h before the real case. Surgical metrics and patient outcomes from both groups (rehearsal vs. standard) were compared. Significant improvements in mean fluoroscopy time, percutaneous needle access attempts, complications, and additional procedures were significantly lower in the rehearsal group (184.8 vs. 365.7s, p < 0.001; 1.9 vs. 3.6 attempts, p < 0.001; 1 vs. 5, p < 0.001; and 1 vs. 5, p < 0.001, respectively). There were no differences in stone free rates, mean patient age, body mass index, or stone size between the two groups. This study demonstrates that patient-specific procedural rehearsal is effective reducing the experience curve for a complex endourological procedure, resulting in improved surgical performance and patient outcomes.