AUA 2013 - Session Highlights: Face and content validation of a patient-specific simulator for laparoscopic renal surgery

SAN DIEGO, CA USA ( - Several training systems simulating surgical procedures are commercially available, but none of them accurately represent patient-specific anatomy.

To address this, a unique training system was developed that integrates patient-specific data into a simulator for laparoscopic surgery. Using specific data for each individual patient, this system enables surgeons to perform a rehearsal operation under virtual reality conditions. The research group from Yokohama City University Hospital performed preoperative simulations using this simulator for 13 patients who underwent renal surgery.

auaDynamic CT of each patient scheduled to undergo renal surgery was captured into a model data generation system. Each patient’s specific volume data for the kidneys and organs around the kidney were extracted and entered into the simulator. In the simulator, the organs of each individual patient were reproduced. The simulation provided tactile to haptic feedback. Three urology expert surgeons performed 13 preoperative simulations. Procedures included 7 nephrectomies, 4 partial nephrectomies, and 2 pyeloplasties. Evaluation included whether or not the anatomies reproduced in the simulator were correct compared with actual operations. Surgeons evaluated the anatomical integrity, efficacy of the simulation, and sense of security during operations on a visual analog scale.

According to the expert surgeons, the simulated anatomy was reproduced almost perfectly compared with intraoperative findings. Minor anatomical variants were also identified, such as the lack of the lumbar vein in the simulator, which could be observed during surgery. Content validation in regards to anatomical integrity, efficacy of simulation, and sense of security during the operation showed average scores of 3.4, 4.2, and 4.1, respectively [using a 1- 5 point scale]. In all 13 simulations, the experts stated that the simulation was useful to predict intraoperative findings, especially in complex cases, such as retroperitoneoscopic nephroureterectomy for urothelial carcinoma of the renal pelvis in a patient with situs inversus totalis.

Ultimately, this novel patient-specific simulator for laparoscopic renal surgery showed excellent reproduction of vessels, collecting system, and adjacent organs, and surgeons deemed it useful as a preoperative training technique, especially in complex cases. Further studies will be necessary to validate the performance of this novel simulator.

Presented by Katzuhide Makiyama, MD at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan


Reported for by Achim Lusch, MD, Research Fellow at UC Irvine Medical Center, Orange, CA USA

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