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19–22 APRIL, 2017, BARCELONA, SPAIN
CONCLUSIONS
Germ call elements, without atypia or dysplasia, were present in 5.1% of remnants in our cohort.
Despite the risk of malignant transformation being low, this does not equate to no risk, therefore it is
our view that testicular remnants should be excised.
S19-13 (P without presentation)
3D PATIENT TAILORED PRINTED HYDRONEPHROSIS:
THE NEW ERA OF SURGICAL EDUCATION
Alaa EL-GHONEIMI
1
, Matthieu PEYCELON
1
, Isabelle LACREUSE
2
,
Laurent FOURCADE
3
, Thomas BLANC
4
, Annabel PAYE-JAOUEN
1
, Christine GRAPIN
5
,
Francois BECMEUR
2
, Arnaud BONNARD
6
and Jean BREAUD
7
1) Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Paediatric Urology, Paris,
FRANCE - 2) Hôpitaux Universitaires de Strasbourg, UFR médecine Strasbourg, Universités de Strasbourg, Strasbour,
Paediatric Surgery and Urology, Strasbourg, FRANCE - 3) CHU Limoges, UFR médecine Limoges, Université de
Limoges, Limoges, France, Paediatric Surgery and Urology, Limoges, FRANCE - 4) Hôpital Necker-Enfants Malades,
APHP, UFR médecine Descartes-Paris V, Université Sorbonne Paris Cite, Paediatric Surgery and Urology, Paris,
FRANCE - 5) Hôpital Universitaire Robert Debré, APHP, UFR médecine Bobigny-Paris XIII, Université Sorbonne Paris,
Paediatric Urology, Paris, FRANCE - 6) Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne
Paris Cité, Paediatric Surgery and Urology, Paris, FRANCE - 7) CHU Lenval, UFR médecine Nice, Université de Nice
Sophia Antipolis, Nice, France, Paediatric Surgery and Urology, Nice, FRANCE
PURPOSE
Laparoscopic suturing remains a challenging procedure especially in pediatric urology field. Though
laparoscopic pyeloplasty has been demonstrated to be efficient in children with minimal morbidity,
the low load of cases makes the standard apprenticeship long, costly and of variable effective-
ness. Training using a box model physical simulator is an option to supplement standard training.
However, the lack of a high fidelity model of hydronephrosis reduces its impact on training. We
aimed to develop a prototype of 3D patient tailored printed model of hydronephrosis.
MATERIAL AND METHODS
The development of the model has followed different steps. The acquisition of the 3D image was
obtained from TDM scan of a child with hydronephrosis secondary to pyelo-ureteric obstruction.
Specific complex procedures were used to reproduce an accurate model of the kidney and to
produce directly a printed 3D organ. This process was done in collaboration with BIOMODEX
specialized in medical education 3D printing.
The results were evaluated by senior pediatric urologists to assess for each specimen of final prod-
uct the following parameters: anatomical morphology, manipulation with laparoscopic instruments
of the renal pelvis and ureter, flexibility, resistance to laparoscopic scissors, resistance to 5/0 and
6/0 needles and sutures.
On the same setting, a pediatric box trainer was developed to recreate a similar working space
limitation as in pediatric laparoscopy.
RESULTS
First prototype is produced with sufficient resemblances to the reality. The different parameters were
satisfying and resection of the UPJ followed by pyelo-ureteral anastomosis was feasible inside the
specifically tailored pediatric laparoscopic trainer.
CONCLUSIONS
This is the first description of patient tailored 3D printed hydronephrosis. This preliminary result is
encouraging and need to be evaluated by different groups of surgeons and trainees. The success
of this experience will open the way in the near future for other complex reconstruction models and
may facilitate the diffusion of minimal invasive surgery in safer and more efficient way.