A hypothesized reason for introducing simulation into surgical practice is the opportunity for the surgeon to repetitively practice a difficult or unusual case, in a risk free environment away from the patient, to anticipate and address potential challenges or complications and to prepare to avoid these at the time of the actual surgery. Makiyama and colleagues, in Japan, have taken a huge step forward in this effort by making this practice format a reality. They have been developing a unique patient-specific laparoscopic renal surgery simulator for more than 3 years and present an impressive clinical application of it here. Utilizing dynamic CT scans of the patient entered into the computer platform of the simulator, patient specific anatomy of the organs, including renal vasculature is then reproduced for the individual patient in the VR images of the simulator, and the surgeon can truly perform a preoperative rehearsal of that patient’s laparoscopic nephrectomy. The simulator includes haptic feedback and realistic bleeding and instrument/tissue interactive resistance, in addition to both a transperitoneal and retroperitoneal perspective of the procedure.
These researchers have now used this patient-specific simulator to preoperatively practice and prepare for a retroperitoneoscopic nephroureterectomy, for a renal pelvis urothelial carcinoma, in a patient with situs inversus totalis. They were able to perform simulation practice for the 2 days prior the operative procedure in which a lymphadenectomy and radical nephroureterectomy were performed. More importantly the detailed vascular anatomy at surgery was exactly what they had anticipated from the simulation, and this improved their intra-operative confidence with minimal blood loss (50ml) and a very reasonable operative time (182 minutes), which is certainly comparable to that for an uncomplicated retroperitoneoscopic nephroureterectomy. The provision of haptic feedback, simulated bleeding, and instrument/tissue interactive properties may make this simulator a much more realistic procedural training platform than presently available commercial devices. This device is truly approaching the degree of fidelity available in aviation industry simulation, but which to date has been lacking in surgical simulation. We eagerly await the construct and deliberative validity testing of this unique simulator.
Presented by Ryoko Sakata at the 29th World Congress of Endourology & SWL (WCE) - November 30 - December 3, 2011 - Kyoto International Conference Center - Kyoto, Japan
Reported for UroToday by Elspeth M. McDougall, M.D., FRCSC, MHPE, Professor of Urology, Department of Urology, University of California-Irvine Medical Center, Irvine, CA
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