title: Laparoscopic Partial Nephrectomy Supported by Training Involving Personalized Silicone Replica Poured in Three-Dimensional Printed Casting Mold.
abstract: BACKGROUND
  Most kidney neoplasms are found incidentally and qualify for nephron-sparing surgery. Laparoscopic approach is beneficial to these patients because of its minimally invasive approach. However, these operations are both difficult and require plenty of experience and extended training. Some stages of the operation are limited by permissible time of transient ischemia. We applied three-dimensional (3D) printing technology to create individual silicone models of kidney to be used for training in laparoscopic procedures before the actual surgeries.
  
  
  METHODS
  Three patients who qualified for laparoscopic partial nephrectomy were selected. Digital models of their kidneys with tumors were designed based on computed tomography scans, followed by creation of silicone models. These were cast into the forms printed in 3D. The proper surgery was preceded by an operation carried out in a silicone model of laparoscopic simulator in which the tumor was excised and lodged after tumorectomy was filled.
  
  
  RESULTS
  Average time of the live kidney tumor operation was slightly shorter than that of the silicone model (16 versus 17 minutes). Relatively short period of ischemia did not exceed 9 minutes. One patient underwent surgery without closing the vascular pedicle.
  
  
  CONCLUSIONS
  Experience gained during training with these silicone models improved the actual surgery and can reduce the need for/duration of intraoperative renal ischemia. We believe this training method can be successfully used in other procedures.
authors.affiliation: 1 Department and Clinic of Urology and Urological Oncology, Pomeranian Medical University , Szczecin, Poland .
authors.forename: Adam
authors.initials: A
authors.lastname: Golab
authors.affiliation: 2 Department of Maxillofacial Surgery, Pomeranian Medical University , Szczecin, Poland .
authors.forename: Tomasz
authors.initials: T
authors.lastname: Smektala
authors.affiliation: 1 Department and Clinic of Urology and Urological Oncology, Pomeranian Medical University , Szczecin, Poland .
authors.forename: Krystian
authors.initials: K
authors.lastname: Kaczmarek
authors.affiliation: 1 Department and Clinic of Urology and Urological Oncology, Pomeranian Medical University , Szczecin, Poland .
authors.forename: Remigiusz
authors.initials: R
authors.lastname: Stamirowski
authors.affiliation: 3 Chair of Urology, Medical University , Poznan, Poland .
authors.forename: Michal
authors.initials: M
authors.lastname: Hrab
authors.affiliation: 1 Department and Clinic of Urology and Urological Oncology, Pomeranian Medical University , Szczecin, Poland .
authors.forename: Marcin
authors.initials: M
authors.lastname: Slojewski
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005658:Fungi; D006801:Humans; D021621:Imaging, Three-Dimensional; D007511:Ischemia; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D008953:Models, Anatomic; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D061646:Operative Time; D059351:Organ Sparing Treatments; D066330:Printing, Three-Dimensional; D012828:Silicones; D000066908:Simulation Training; D014057:Tomography, X-Ray Computed
chemical_list: D012828:Silicones
keywords: 3D printing; laparoscopic surgery; nephrectomy; renal cell carcinoma; silicone