This chapter presents a research which aims to increase accessibility and availability of surgical training in robot-assisted laparoscopic partial nephrectomy (RALPN) by producing and evaluating a low-cost training model.
A methodological and technological framework is presented with a case study which uses image segmentation and 3D-modelling software to create anatomically accurate 3D-printed moulds from an abdominal CT scan of a patient who had stage T1b renal cell carcinoma. The moulds were injected with hydrogel and fitted with an artificial renal artery to allow for simulation of blood flow. The face validity (appearance and feel) of the prototype was evaluated using a 5-point Likert-style questionnaire by surgical staff (N = 8) who held and inspected the model. Content validity (how successfully the model simulates a RALPN) was evaluated by expert and trainee urology surgeons (N = 4) who performed a RALPN on the prototype using the da Vinci Robotic Surgical System. Qualitative data regarding perceptions of the usefulness of the model was also collected.
The final cost of the prototype was £1.72 for single-use materials and £4.02 in total. Within this sample population the prototype achieved face validity with both the overall appearance (M=4.13 ± 0.35) and overall feel of the model scoring (M=4.13 ± 0.64). The prototype also demonstrated content validity within this sample population, with an overall average of M= 3.92 and the highest performing measures in “needle driving” (M= 4.75 ± 0.5) and “suture holding” (M= 4.25 ± 0.96). Qualitative feedback suggested the potential significant benefits of such a training model to give junior surgeons exposure to robotic techniques in training.
This research demonstrates a low-cost method of producing a physical model for RALPN training. The prototype developed was considered to be an effective training tool by both experienced and trainee surgeons. Through further development of this prototype, urology surgical training programmes could have access to a cost-effective and simple means of widening access to RALPN training and implementing it at an earlier stage of training.