Mechanical and functional validation of a perfused, robot-assisted partial nephrectomy simulation platform using a combination of 3D printing and hydrogel casting

Melnyk, Rachel; Ezzat, Bahie; Belfast, Elizabeth; Saba, Patrick; Farooq, Shamroz; Campbell, Timothy; McAleavey, Stephen A.; Buckley, Mark R.; Ghazi, Ahmed

doi:10.1007/s00345-019-02989-z

Cited by 50 publications

(44 citation statements)

References 29 publications

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“…Guided by studies demonstrating that porcine kidneys can be used as human surrogates [17], we tested fresh porcine kidneys using a series of mechanical (unconfined uniaxial compression, indentation and elastography testing) and functional tests (to test bleeding and suturing). Our published results demonstrated that PVA kidneys, fabricated using 7% PVA at three freeze–thaw cycles closely approximated the mechanical and functional properties of live kidney tissue [18].…”

Section: Methodsmentioning

confidence: 99%

Multi‐institutional validation of a perfused robot‐assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS)

et al. 2020

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Objective To conduct a multi‐institutional validation of a high‐fidelity, perfused, inanimate, simulation platform for robot‐assisted partial nephrectomy (RAPN) using incorporated clinically relevant objective metrics of simulation (CROMS), applying modern validity standards. Materials and Methods Using a combination of three‐dimensional (3D) printing and hydrogel casting, a RAPN model was developed from the computed tomography scan of a patient with a 4.2‐cm, upper‐pole renal tumour (RENAL nephrometry score 7×). 3D‐printed casts designed from the patient’s imaging were used to fabricate and register hydrogel (polyvinyl alcohol) components of the kidney, including the vascular and pelvicalyceal systems. After mechanical and anatomical verification of the kidney phantom, it was surrounded by other relevant hydrogel organs and placed in a laparoscopic trainer. Twenty‐seven novice and 16 expert urologists, categorized according to caseload, from five academic institutions completed the simulation. Results Clinically relevant objective metrics of simulators, operative complications, and objective performance ratings (Global Evaluative Assessment of Robotic Skills [GEARS]) were compared between groups using Wilcoxon rank‐sum (continuous variables) and parametric chi‐squared (categorical variables) tests. Pearson and point‐biserial correlation coefficients were used to correlate GEARS scores to each CROMS variable. Post‐simulation questionnaires were used to obtain subjective supplementation of realism ratings and training effectiveness. Results Expert ratings demonstrated the model’s superiority to other procedural simulations in replicating procedural steps, bleeding, tissue texture and appearance. A significant difference between groups was demonstrated in CROMS [console time (P < 0.001), warm ischaemia time (P < 0.001), estimated blood loss (P < 0.001)] and GEARS (P < 0.001). Six major intra‐operative complications occurred only in novice simulations. GEARS scores highly correlated with the CROMS. Conclusions This perfused, procedural model offers an unprecedented realistic simulation platform, which incorporates objective, clinically relevant and procedure‐specific performance metrics.

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Section: Methodsmentioning

confidence: 99%

Multi‐institutional validation of a perfused robot‐assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS)

et al. 2020

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“…This will have clear benefits for the patients treated with this technology and is already being used in the field of urology. 41 Economic costs remain one of the major concerns, although evaluation should not only consider the capital cost of acquisition, or the costs related to the procedure, but also the benefits from the different aspects related to the patient treatment, such as oncological outcomes. To date, there are no large-scale studies that have evaluated this aspect from a global point of view.…”

Section: Indications For Robotic Surgery In Colorectal Fieldmentioning

confidence: 99%

Robotic surgery for colorectal cancer

Ruiz

Escribano

Fernández

et al. 2020

Annals of Gastroent Surgery

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Throughout its more than 20 years of activity, surgical robot systems have been incorporating different improvements that replace the inherent limitations of laparoscopic surgery. Some of these improvements consist of changes in the ergonomics and reproduction of hand movements with articulated instruments. In addition, infrared technology and slimmer arms have been incorporated to facilitate procedures in multiple abdominal quadrants without requiring repositioning. This development in technology has meant that more robotic procedures are performed each year is in general surgery. It has experienced important growth in the colorectal field, where it is shown to be feasible and safe.

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“…This process, created by the Simulation Innovation Lab (University of Rochester Medical Center, Rochester, NY), was effectively utilized to create a perfused kidney phantom for partial nephrectomy simulations that mimics the mechanical and functional properties of all components of fresh kidney tissue. 13 The result of the application of this process is a perfused hydrogel donor kidney graft model that allows the surgeon to mimic dissection, cauterization, and suturing ( Fig. 1).…”

Section: Fabrication Of the Simulation Modelmentioning

confidence: 99%

“…Mechanical testing following an established protocol was performed to determine the Young's modulus of human iliac vessel segments discarded from liver transplant surgeries. 13 The same test was done on a catalogue of various PVA conditions (changing freeze thaws, concentrations, and additives) until an acceptable replicate was found that mimicked the Young's modulus value of the live tissue (average Young's modulus = 28.125 MPa).…”

Section: Fabrication Of the Simulation Modelmentioning

confidence: 99%

Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies

Saba

Belfast

Melnyk

et al. 2020

Journal of Endourology

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Introduction and Objective: Despite the adoption of robotic donor nephrectomy, the steep learning curve of robotic recipient transplantation has hindered the implementation of a complete robot-assisted kidney transplantation (RAKT). We sought to develop a high-fidelity perfused full immersion nonbiohazardous platform for RAKT simulation training. Methods: A three-dimensional (3D) computer-aided design (CAD) model consisting of a kidney, pelvicaliceal system, renal artery, and vein was created from a CT scan of a donor patient. 3D printed casts designed from the CAD model were injected with various polyvinyl alcohol hydrogel formulations to fabricate an anatomical kidney phantom and surrounding abdominal cavity. The process was repeated using a recipient's CT scan to create the recipient pelvic model containing a bony pelvis, pelvic musculature, iliac arteries and veins, and bladder. Donor and recipient models each contained structures to simulate the perfused vascular and ureterovesical anastomosis. A board-certified transplant surgeon completed a robotic training curriculum, including four RAKT simulation procedures, from procurement of the donor kidney to final retroperitonealization. Metrics from the simulations (e.g., arterial, venous, ureterovesical, and total anastomosis times) were recorded and compared with surgical times from published data. Results: The average time for the nephrectomies was 67.33 (-31.58) minutes. The average total anastomosis time was 60.85 (-9.73) minutes with 20.37 (-3.87), 20.17 (-4) and 15.1 (-2.35) minutes for arterial, venous, and ureterovesical anastomosis, respectively. The recorded arterial and venous anastomosis times were within published times for competency (D = 2.47 and D = 2.87, respectively), whereas the uterovesical time was within the mastery range (D = 0.45). Conclusions: Using a combination of 3D printing and hydrogel casting technologies, a high fidelity perfused full-immersion nonbiohazardous simulation platform for RAKT was developed. The utilization of this platform has the potential to replace the early cases in a learning curve while decreasing the barriers to utilization for transitioning transplant surgeons.

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Mechanical and functional validation of a perfused, robot-assisted partial nephrectomy simulation platform using a combination of 3D printing and hydrogel casting

Cited by 50 publications

References 29 publications

Multi‐institutional validation of a perfused robot‐assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS)

Multi‐institutional validation of a perfused robot‐assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS)

Robotic surgery for colorectal cancer

Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies

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