ObjectivesTo incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP).
Materials and MethodsAnatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into threedimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. Incorporating clinical metrics in a RARP model sparing radical prostatectomy and fruit for simple prostatectomy. Korean J Urol 2011; 52: 130-5 34 Clarebrough E, Christidis D, Lindner U, Fernandes K, Fleshner N, Lawrentschuk N. Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy. World J Urol 2019; 37: 799-804
This study demonstrates that IVUS can detect and measure the extent of arterial damage following pulsed laser ablation. This may provide a means of detecting the extent of tissue disruption and help develop approaches to reduce or prevent extensive tissue damage.
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