New ex-vivo organ model for percutaneous renal surgery

Percutaneous Renal Surgery (PRS) is a demanding procedure and success is mostly hampered by the lacking of training facilities. Thus, the purpose of the study was to evaluate a significantly improved pre-existing porcine kidney-training model for percutaneous renal access and PRS.

A biologic training model using porcine kidneys coated by a full-thickness porcine skin flap was prepared. The ureter was dissected, stones were placed into the collecting system using an 18F amplatz sheath, and a catheter was placed in the ureter for further irrigation with saline or contrast medium. For initial training with an easy access, a standard guide-wire was inserted in the ureter through the renal parenchyma. The kidney was punctured with radiographic or ultrasound guidance. Minimally invasive percutaneous nephrolithotomy (MIP) was then tested using the model under radiographic or ultrasound guidance. The model was then evaluated in MIP training courses, which are regularly held at The Hannover Medical School.

All trainees were urologists with experience in endourologic surgery but lacked practice in PRS. In conclusion, all 36 participants attained access to the collecting system using models with readily placed guide-wires. Subsequently, PRS was successful in all cases. Percutaneous puncture under ultrasound guidance and following intrarenal surgery was successful in 30 (83.3%) cases. Therefore, all participants rated the model useful for simulating percutaneous renal surgery.

This new porcine kidney model is easy to build and is made cost effective by using readily available material. Moreover, it provides realistic and reproducible training model for PRS. The "organ" model mimics the retroperitoneum by having a full-thickness skin flap with a layer of subcutaneous fatty tissue.