Many commercially available laparoscopic simulators aim at the mastery of basic skills by practice with a programmed tutorial. These simulators can evaluate the basic skills by measuring the time or movement of forceps
[2, 11]. On the other hand, because our simulator uses specific data of each individual patient, it meets the demands of a trained doctor who wants to simulate a complicated surgery. In renal and ureteral surgeries, the network of arteries and veins is complicated and varies. Therefore, we should obtain detailed information and be well prepared to avoid confusion and complications during the surgery. In fact, the vascular structure is complicated and reconstruction of the 3D data in our UPJO case was very time-consuming. Therefore, there were some structural differences between the simulated and actual vascular networks.
The higher the resolution of the images, the more accurate the reconstructed 3D images. Some reports suggested that a slice thickness of about 2mm is required to construct clear 3D images
[12, 13]. At present, we are trying to combine the CT data (precontrast image, arterial phase, and nephrographic phase) and to improve the software so that tumors, vessel trees, or urinary ducts are highlighted in the simulation. (Now it can be depicted only in the software.) If we acquire more information about the patient, the precision of our simulator will improve. We are also trying to include the organ’s properties in the simulator so that it will provide a more realistic situation in the future.
By means of a patient-specific simulator, surgeries may be more accurate and proceed more smoothly because the surgeon has accurate anatomical information. In addition, it is possible that the time required for surgery, pre-operative risks, and complications will decrease. As we are finding from other clinical cases, surgeons could carry out meaningful pre-operative training and stated that the simulation was useful for constructing pre-operative images, although the operation time was not decreased. Trocar positions, which were simulated, were appropriate in other cases
We need to validate the functionality of this simulator and improve the precision of the reconstructed 3D images before it can be made commercially available. However, we are cooperating with gynecology and general surgery departments to put our simulator to use, so we are confident that it will be the next-generation operative technology. (Our project is also available online