Robotic Dismembered Pyeloplasty Surgical Simulation using a 3D-printed Silicone-based Model: Development, Face Validation, and Crowdsourced Learning Outcomes Assessment
Hersh Bendre, BSc; Archana Rajender, MD; Phil Barbosa, MD; Shaun Wason, MD
Boston University School of Medicine, Boston, MA
BACKGROUND: Ureteropelvic junction obstruction (UPJO) is an uncommonly encountered pathology and training residents to perform robotic dismembered pyeloplasty poses unique challenges. We describe the development and face validation of a robotic-assisted pyeloplasty simulation using a 3-dimensional (3D) printed silicone-based model of UPJO for surgical training. In addition, we demonstrate the use of a crowdsourced platform to objectively assess surgical performance and learning outcomes.
METHODS: The organs (kidney, renal pelvis, and ureter) were created using 3D modeling software and printed using a silicone-based material (Lazarus 3D, LLC., Houston, TX, USA). The model was secured in a laparoscopic box trainer and the da Vinci® robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA) was docked. 6 residents and one faculty member assessed our skills module. Participants independently performed a robotic-assisted right dismembered pyeloplasty using 3-0 prolene on a RB-1 needle, on two separate occasions. Face validity was demonstrated on a 5-point Likert scale. Crowd-Sourced Assessment of Technical Skills (C-SATS Inc., Seattle, WA, USA) scored surgical performance using the Global Evaluative Assessment of Robotic Skills (GEARS) criteria, based on video review of a standardized segment of each simulation.
RESULTS: The dry-laboratory model consists of a kidney, a dilated renal pelvis and ureter with an obstructed ureteropelvic junction. All participants were able to complete the robotic-assisted dismembered pyeloplasty simulation twice with fully patent anastomoses. Average total time to complete the initial procedure was 52 ± 13 minutes (range 38-75). 43% of participants were able to improve the speed of their anastomosis on the second attempt. During initial validation, participants rated (out of 5) 4.1 ± 0.4 for the overall feel of the model, 3.7 ± 0.5 for realism, 4.7 ± 0.5 for usability, 4.9 ± 0.4 for suturability, and 4.3 ± 0.5 for aesthetics. 57% of participants reported feeling very or extremely confident that they could perform a complete anastomosis at the end of the study, compared to 29% prior to the simulations. All participants felt that this simulation was a useful addition to their surgical training.
CONCLUSIONS: Using 3D-printed silicone-based models, participants were able to perform a complete robotic-assisted dismembered pyeloplasty for training and skills acquisition. The model′s usability, realism, suturability, and resultant improvement in participant confidence show promise as an educational tool for skills acquisition of infrequently encountered pathology.
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