title: Utility of patient-specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot-assisted laparoscopic partial nephrectomy.
abstract: To describe our experience using patient-specific tissue-like kidney models created with advanced three-dimensional (3D)-printing technology for preoperative planning and surgical rehearsal prior to robot-assisted laparoscopic partial nephrectomy (RALPN).
  
  
  
  A feasibility study of 10 patients with solid renal masses who underwent RALPN after preoperative rehearsal using 3D-print kidney models. A single surgeon performed all surgical rehearsals and procedures. Using standard preoperative imaging and 3D reconstruction, we generated pre-surgical models using a silicone-based material. All surgical rehearsals were performed using the da Vinci®robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA) before the actual procedure. To determine construct validity, we compared resection times between the model and actual tumour in a patient-specific manner. Using 3D laser scanning in the operating room, we quantified and compared the shape and tumour volume resected for each model and patient tumour.
  
  
  
  We generated patient-specific models for 10 patients with complex tumour anatomy. R.E.N.A.L. nephrometry scores were between 7 and 11, with a mean maximal tumour diameter of 40.6 mm. The mean resection times between model and patient (6:58 vs 8:22 min, P = 0.162) and tumour volumes between the computer model, excised model, and excised tumour (38.88 vs 38.50 vs 41.79 mm3, P = 0.98) were not significantly different.
  
  
  
  We have developed a patient-specific pre-surgical simulation protocol for RALPN. We demonstrated construct validity and provided accurate representation of enucleation time and resected tissue volume. This simulation platform can assist in surgical decision-making, provide preoperative rehearsals, and improve surgical training.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.|Department of Urology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.
authors.forename: Friedrich-Carl
authors.initials: FC
authors.lastname: von Rundstedt
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Scovell
authors.affiliation: Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Smriti
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Lazarus 3D LLC, Houston, TX, USA.
authors.forename: Jacques
authors.initials: J
authors.lastname: Zaneveld
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.|Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.|Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Link
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008953:Models, Anatomic; D009392:Nephrectomy / Q000379:methods / Q000639:trends; D057285:Precision Medicine / Q000379:methods*; D066330:Printing, Three-Dimensional; D065287:Robotic Surgical Procedures / Q000379:methods*; D012828:Silicones
chemical_list: D012828:Silicones
keywords: 
  RALPN
  ; #KCSM; #KidneyCancer; 3D printing; robotic partial nephrectomy; surgical simulation