*Purpose: Robotic-assisted kidney transplantation is an innovative application of the robotic surgery platform. Early experiences suggest that it is associated with comparable graft function, less pain, fewer incisional complications, less blood loss, and better cosmesis. Simulation on fully customized patient specific anatomical models has provided a realistic platform for trainee and expert operators to rehearse the surgery, potentially reducing the number of medical errors. We are the first to report our pilot experience with surgical simulated rehearsal of living donor transplant nephrectomy using high fidelity, perfused, patient-specific hydrogel models.

*Methods: Four living healthy kidney donors (3 left and 1 right) cleared for donation were chosen for preoperative simulation and rehearsal. DICOM files from patients CT scans were converted to a virtual computer assisted design using a segmentation software (Mimics 20.0, Mimics, Materialise, Belgium). A combination of 3D printing and hydrogel (PVA) molding converts these virtual designs into anatomically accurate hydrogel models including: kidney with incorporated vasculature and pelvicaliceal system (PCS), renal vein, renal artery, inferior vena cava, abdominal aorta, fat layers, peritoneum and partial colon segment. These were then assembled in anatomic orientation into a replicated hemi-abdomen, processed for organ cohesion. The transplant surgeon practiced at least one week prior to the live surgery using a daVinci Xi surgical robot in an operating room.

*Results: All 4 preoperative simulations were completed prior to the live cases. Donor nephrectomy was successful in all 4 cases with an average blood loss of 40cc and console time of 2.3 hours. All cases had single renal artery and vein except one with two arteries and an early bifurcation. In the case with double renal arteries, preoperative 3D processing and hydrogel kidney aided in assessing the complex arterial anatomy of the pelvicaliceal system. In all cases, the preoperative rehearsals were analogous with the live cases. A video of the fabrication process, preoperative simulation and live cases will be presented at the meeting on acceptance of the abstract.

*Conclusions: Using 3D printing technology and polymer research, we are the first to report our experience with creating hydrogel models accurately replicating the kidney donor operative experience. This pilot study demonstrates that patient-specific procedural rehearsal is effective in enhancing the performance of expert surgeons with the potential to positively impact donor outcomes. It is also a promising tool for teaching trainees in a stress-free milieu.

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