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A Novel High-Fidelity Robot-Assisted Radical Prostatectomy Simulator
Mehrdad Alemozaffar, M.D.1, Ramkishen Narayanan, B.S.1, Brian Minnillo, M.D.2, Ignacio San Francisco, M.D.1, Kai Matthes, M.D.1, Hiep Nguyen, M.D2, Andrew Wagner, M.D.1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Children's Hospital Boston, Boston, MA, USA.

Introduction: There is a paucity of realistic simulators for robotic-assisted radical prostatectomy (RARP) despite the realization that they can shorten the well-known learning curve. Existing ex-vivo models focus only on the vesicourethral anastomosis, failing to provide training for other steps. Our goal was to create a high-fidelity, ex-vivo tissue-based simulator that allows practice of key steps of RARP in a sequential fashion.
Methods: A mock-up of the human male genitourinary system as relevant to RARP was created from female porcine genitourinary tract tissue to represent the urethra, bladder, prostate, pedicles, seminal vesicles, rectum, dorsal venous complex (DVC) and neurovascular bundles. This model was placed into a replica of the human pelvis and positioned under the da Vinci Surgical System. The following steps of RARP can be simulated: ligation of the DVC, division of the vesicoprostatic junction, dissection of the seminal vesicles, ligation of the prostatic pedicles with preservation of the neurovascular bundles, division of the urethra, bladder neck reconstruction, and vesicourethral anastomosis.
Results: All of the aforementioned steps of RARP were performed sequentially and are demonstrated in the video with a side-by-side comparison to a real RARP. Image 1 shows the anatomy recreated by the simulator. Image 2 demonstrates DVC ligation. Image 3 reveals the anatomy after dividing the vesicoprostatic junction and dissecting the seminal vesicles. Image 4 demonstrates nerve-sparing prostatic pedicle dissection. Image 5 depicts urethral division. Image 6 demonstrates the first urethral suture initiating the vesicourethral anastomosis. Image 7 demonstrates the first anastomotic bladder suture and the reconstructed bladder neck. Image 8 illustrates conclusion of the simulator.
Conclusions: We created a high-fidelity, ex-vivo, tissue-based simulator to allow for training of key surgical steps of RARP in a sequential fashion. Ultimately, this simulator could be incorporated into urology residency/fellowship training or facilitate surgeons transitioning from open prostatectomy to RARP.


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