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Mason MM, Richardson KD, Carino Mason MR, Swonger RM, Emami S, Anantha S, Thornton LM. Two Affordable, High-Fidelity Central Venous Models for Ultrasound-Guided Interventional Training. Simul Healthc 2023:01266021-990000000-00075. [PMID: 37440430 DOI: 10.1097/sih.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Ultrasound-guided vascular access is an increasingly popular technique due to its reduced complication and higher success rates. Commercially bought training phantoms allow providers to develop tactile skills in a low-risk setting, but are also expensive and poorly accessible. This study analyzes the efficacy of homemade, low-cost, gelatin-based central line vascular models to teach vascular anatomy and intravascular access techniques in training physicians. METHODS A gelatin mold was created using a mixture of unflavored gelatin, hot water, psyllium husk powder, and rubbing alcohol. Latex tubing, balloons, precooked hot dog, and tofu were inserted to simulate arteries, veins, nerves, and the sternocleidomastoid muscle, respectively. Medical students from a single institution participated in a 90-minute workshop led by interventional radiology residents. Participants completed presurveys and postsurveys that assessed knowledge acquisition and confidence levels related to acquiring central access. All images were obtained using a USB-C Butterfly iQ probe. RESULTS Twenty medical students were analyzed after the workshop. There was a statistically significant increase in self-reported confidence in basic ultrasound use (adjusting gain, depth, probe manipulation), localizing major anatomical structures, using ultrasound for vessel access, and reported ease in identifying muscle, nerves, and major blood vessels under ultrasound. There was also a significant increase in correctly identified anatomical landmarks after the workshop, including the sternocleidomastoid muscle, internal jugular vein, carotid artery, femoral nerve, femoral artery, and femoral vein. CONCLUSIONS Our findings suggest that our homemade, low-cost, gelatin-based models were effective in teaching vascular anatomy and ultrasound-guided vascular access techniques to training physicians.
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Affiliation(s)
- Matthew M Mason
- From the University of Miami Miller School of Medicine (M.M.M., K.D.R., M.R.C., R.M.S., S.E., S.A.), Miami, FL; and Department of Interventional Radiology (L.M.T.), University of Miami Miller School of Medicine, Miami, FL
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2
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Luu T, Gonzalez RR. Residency Surgical BPH Training Paradigms from MIST to HOLEP. Curr Urol Rep 2023; 24:261-269. [PMID: 36947390 DOI: 10.1007/s11934-023-01153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW Benign prostatic hyperplasia (BPH) is a common medical condition of older men that often requires medical or surgical therapy. Surgical options for BPH have grown exponentially over the last two decades. The numerous options and/or lack of access to them can make it challenging for new trainees to gain proficiency. We examine the literature for available BPH surgical simulators, learning curves, and training pathways. RECENT FINDINGS Each BPH surgical therapy has a learning curve which must be overcome. There is an abundance of TURP simulators which have shown face, content, and construct validity in the literature. Similarly, laser therapies have validated simulators. Newer technologies do have available simulators, but they have not been validated. There are strategies to improve learning and outcomes, such as having a structured training program. Simulators are available for BPH surgical procedures and some have been implemented in urology residencies. It is likely that such simulation may make urologists more facile on their learning curves for newer technologies. Further studies are needed. Future directions may include integration of simulator technology into training pathways that include surgical observation and proctorship.
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Affiliation(s)
- Thaiphi Luu
- Department of Urology, Scurlock Tower, Houston Methodist Hospital, Suite 2100, 6560 Fannin St, Houston, TX, 77030, USA.
| | - Ricardo R Gonzalez
- Department of Urology, Scurlock Tower, Houston Methodist Hospital, Suite 2100, 6560 Fannin St, Houston, TX, 77030, USA
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Dinh J, Yamashita A, Kang H, Gioux S, Choi HS. Optical Tissue Phantoms for Quantitative Evaluation of Surgical Imaging Devices. ADVANCED PHOTONICS RESEARCH 2023; 4:2200194. [PMID: 36643020 PMCID: PMC9838008 DOI: 10.1002/adpr.202200194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Optical tissue phantoms (OTPs) have been extensively applied to the evaluation of imaging systems and surgical training. Due to their human tissue-mimicking characteristics, OTPs can provide accurate optical feedback on the performance of image-guided surgical instruments, simulating the biological sizes and shapes of human organs, and preserving similar haptic responses of original tissues. This review summarizes the essential components of OTPs (i.e., matrix, scattering and absorbing agents, and fluorophores) and the various manufacturing methods currently used to create suitable tissue-mimicking phantoms. As photobleaching is a major challenge in OTP fabrication and its feedback accuracy, phantom photostability and how the photobleaching phenomenon can affect their optical properties are discussed. Consequently, the need for novel photostable OTPs for the quantitative evaluation of surgical imaging devices is emphasized.
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Affiliation(s)
- Jason Dinh
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Atsushi Yamashita
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Homan Kang
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sylvain Gioux
- Intuitive Surgical Sàrl, 1170 Aubonne, Switzerland
- ICube Laboratory, University of Strasbourg, 67081 Strasbourg, France
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
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A High-Fidelity Artificial Urological System for the Quantitative Assessment of Endoscopic Skills. J Funct Biomater 2022; 13:jfb13040301. [PMID: 36547561 PMCID: PMC9784860 DOI: 10.3390/jfb13040301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Minimally-invasive surgery is rapidly growing and has become a standard approach for many operations. However, it requires intensive practice to achieve competency. The current training often relies on animal organ models or physical organ phantoms, which do not offer realistic surgical scenes or useful real-time feedback for surgeons to improve their skills. Furthermore, the objective quantitative assessment of endoscopic skills is also lacking. Here, we report a high-fidelity artificial urological system that allows realistic simulation of endourological procedures and offers a quantitative assessment of the surgical performance. The physical organ model was fabricated by 3D printing and two-step polymer molding with the use of human CT data. The system resembles the human upper urinary tract with a high-resolution anatomical shape and vascular patterns. During surgical simulation, endoscopic videos are acquired and analyzed to quantitatively evaluate performance skills by a customized computer algorithm. Experimental results show significant differences in the performance between professional surgeons and trainees. The surgical simulator offers a unique chance to train endourological procedures in a realistic and safe environment, and it may also lead to a quantitative standard to evaluate endoscopic skills.
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Deyirmendjian C, Nguyen DD, Andonian S, Aubé-Peterkin M, Letendre J, Elterman D, Zorn KC, Chughtai B, Miernik A, Gross AJ, Bhojani N. Simulation-based prostate enucleation training: Initial experience using 3D-printed organ phantoms. Can Urol Assoc J 2022; 16:409-416. [PMID: 36656697 PMCID: PMC9851226 DOI: 10.5489/cuaj.7838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Anatomical endoscopic enucleation of the prostate (AEEP) is an effective treatment for benign prostatic hyperplasia (BPH); however, there is controversy regarding the difficulty of learning such a technique. Simulation-based training can mimic real-life surgeries and help surgeons develop skills they can transfer to the operating room, thereby improving patient safety. This study aimed to evaluate the validity of a novel organ phantom for use in AEEP simulation training. METHODS Participants performed AEEP on organ phantom simulators during a Masterclass using one of three energy modalities: holmium:YAG laser, thulium fiber laser, or bipolar energy. The organ phantom is composed of hydrogels and uses 3D molds to recreate prostatic tissue. Participants completed a questionnaire assessing content validity, face validity, feasibility, and acceptability of using the prostate organ phantom. RESULTS The novice group consisted of 13 urologists. The median number of AEEP previously performed was 0 (interquartile range [IQR] 0-2). Two experts in AEEP (surgeons having performed over 100 AEEP interventions) also participated. All participants agreed or strongly agreed that there is a role for simulators in AEEP training. Participants positively rated the overall operative experience (7.3/10). Morcellation (4.7/10) and hemostasis (3.1/10) were deemed the least realistic steps. All participants considered it feasible to incorporate this organ phantom into training programs and 92.9% agreed that it teaches skills transferrable to the operating room. CONCLUSIONS This study has established content and face validity for AEEP with three different energy sources for an organ phantom. Participants considered its use both feasible and appropriate for AEEP training purposes.
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Affiliation(s)
| | | | - Sero Andonian
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Julien Letendre
- Division of Urology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Dean Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Kevin C. Zorn
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, United States
| | | | - Andreas J. Gross
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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Kim DY, Tan X, Li D, Yilmaz M, Miernik A, Qiu T. A Hybrid Surgical Simulator for Interactive Endoscopic Training. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:971-974. [PMID: 36086164 DOI: 10.1109/embc48229.2022.9871697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Endoscopy serves as an indispensable minimally-invasive surgical procedure. Due to the limited view and non-intuitive operation of the instrument, the mastery of endoscopic manipulation requires deep medical knowledge as well as complex perception and motor skills of the surgeon. Intensive surgical training is required, and simulation-based training is of more and more importance over traditional animal- or cadaver-based approaches. Here, we developed a hybrid surgical simulator that consists of a realistic physical organ model and an artificial intelligence (AI)-driven cyber model. We built a physical model of the full urinary tract with soft materials and detailed blood vessel structures. Endourological procedures were performed to localize and treat renal calculi by a flexible endoscope. An AI algorithm detects the lesions automatically with high accuracy and provides quantitative feedback about an operator's endoscopic skills. The hybrid simulator system shows great potential as an interactive and personalized learning environment for endoscopic skills. Clinical Relevance- This work establishes a preliminary approach for realistic endoscopic training. The developed hybrid surgical simulator - with high-fidelity physical organ models and quantitative feedback - can deliver effective hands-on learning to surgeons to improve their endoscopic skills.
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2022 Athanasiou Student and Post-Doc Awards. Ann Biomed Eng 2022. [PMID: 35727466 DOI: 10.1007/s10439-022-02995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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8
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Rowson B. 2021 ABME Paper Awards. Ann Biomed Eng 2022. [DOI: 10.1007/s10439-022-02915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tokas T, Ortner G, Peteinaris A, Somani BK, Herrmann T, Nagele U, Veneziano D, Gözen AS, Kallidonis P. Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology. World J Urol 2021; 40:1091-1110. [PMID: 34800135 DOI: 10.1007/s00345-021-03886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Transurethral resection (TURP) and photoselective vaporization of the prostate (PVP) constitute established surgical options to treat benign prostate hyperplasia. We investigated the current literature for simulators that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum. METHODS A literature search was performed using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL. Search terms included: Simulat*, train*, curricull*, transurethral, TUR*, vaporesect*, laser. The efficacy of different simulators and the impact of different devices, curricula and courses in training and trainee learning curves were the primary endpoints. RESULTS Thirty-one studies are selected and presented. Validated virtual reality TURP simulators are the UW VR, PelvicVision, Uro-Trainer, and TURPsim™. Validated synthetic TURP models are Dr. K. Forke's TURP trainer, Bristol TURP trainer, different tissue prostate models, and 3D-printed phantoms. The Myo Sim PVP and the GreenLightTM are sufficiently validated PVP simulators. Several TURP and PVP training curricula have been developed and judged as applicable. Finally, the TURP modules of the European Urology Residents Education Programme (EUREP) Hands-on Training course and the Urology Simulation Bootcamp Course (USBC) are the most basic annual TURP courses identified in the international literature. CONCLUSIONS Simulators and courses or curricula are valuable learning and training TURP/PVP tools. The existent models seem efficient, are not always adequately evaluated and accepted. As part of training curricula and training courses, the use of training simulators can significantly improve quality for young urologists' education and clinical practice.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria. .,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Thomas Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | | | - Ali Serdar Gözen
- Department of Urology, SLK Kliniken, Klinikum Heilbronn, Heilbronn, Germany
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10
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A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education. J Robot Surg 2021; 16:749-763. [PMID: 34480323 PMCID: PMC8415702 DOI: 10.1007/s11701-021-01302-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/23/2021] [Indexed: 11/27/2022]
Abstract
We conducted a comprehensive review of surgical simulation models used in robotic surgery education. We present an assessment of the validity and cost-effectiveness of virtual and augmented reality simulation, animal, cadaver and synthetic organ models. Face, content, construct, concurrent and predictive validity criteria were applied to each simulation model. There are six major commercial simulation machines available for robot-assisted surgery. The validity of virtual reality (VR) simulation curricula for psychomotor assessment and skill acquisition for the early phase of robotic surgery training has been demonstrated. The widespread adoption of VR simulation has been limited by the high cost of these machines. Live animal and cadavers have been the accepted standard for robotic surgical simulation since it began in the early 2000s. Our review found that there is a lack of evidence in the literature to support the use of animal and cadaver for robotic surgery training. The effectiveness of these models as a training tool is limited by logistical, ethical, financial and infection control issues. The latest evolution in synthetic organ model training for robotic surgery has been driven by new 3D-printing technology. Validated and cost-effective high-fidelity procedural models exist for robotic surgery training in urology. The development of synthetic models for the other specialties is not as mature. Expansion into multiple surgical disciplines and the widespread adoption of synthetic organ models for robotic simulation training will require the ability to engineer scalability for mass production. This would enable a transition in robotic surgical education where digital and synthetic organ models could be used in place of live animals and cadaver training to achieve robotic surgery competency.
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Choi E, Waldbillig F, Jeong M, Li D, Goyal R, Weber P, Miernik A, Grüne B, Hein S, Suarez-Ibarrola R, Kriegmair MC, Qiu T. Soft Urinary Bladder Phantom for Endoscopic Training. Ann Biomed Eng 2021; 49:2412-2420. [PMID: 34002287 PMCID: PMC8455490 DOI: 10.1007/s10439-021-02793-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023]
Abstract
Bladder cancer (BC) is the main disease in the urinary tract with a high recurrence rate and it is diagnosed by cystoscopy (CY). To train the CY procedures, a realistic bladder phantom with correct anatomy and physiological properties is highly required. Here, we report a soft bladder phantom (FlexBlad) that mimics many important features of a human bladder. Under filling, it shows a large volume expansion of more than 300% with a tunable compliance in the range of 12.2 ± 2.8 - 32.7 ± 5.4 mL cmH2O-1 by engineering the thickness of the bladder wall. By 3D printing and multi-step molding, detailed anatomical structures are represented on the inner bladder wall, including sub-millimeter blood vessels and reconfigurable bladder tumors. Endoscopic inspection and tumor biopsy were successfully performed. A multi-center study was carried out, where two groups of urologists with different experience levels executed consecutive CYs in the phantom and filled in questionnaires. The learning curves reveal that the FlexBlad has a positive effect in the endourological training across different skill levels. The statistical results validate the usability of the phantom as a valuable educational tool, and the dynamic feature expands its use as a versatile endoscopic training platform.
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Affiliation(s)
- Eunjin Choi
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Frank Waldbillig
- Department of Urology & Urosurgery, University Medical Centre Mannheim, Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
| | - Moonkwang Jeong
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Dandan Li
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Rahul Goyal
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Patricia Weber
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
| | - Arkadiusz Miernik
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Britta Grüne
- Department of Urology & Urosurgery, University Medical Centre Mannheim, Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
| | - Simon Hein
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Maximilian Christian Kriegmair
- Department of Urology & Urosurgery, University Medical Centre Mannheim, Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- RaVeNNA 4pi - Consortium of the German Federal Ministry of Education and Research (BMBF), Mannheim, Germany
| | - Tian Qiu
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany.
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany.
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Abstract
PURPOSE OF REVIEW This review aims to summarize innovations in urologic surgical training in the past 5 years. RECENT FINDINGS Many assessment tools have been developed to objectively evaluate surgical skills and provide structured feedback to urologic trainees. A variety of simulation modalities (i.e., virtual/augmented reality, dry-lab, animal, and cadaver) have been utilized to facilitate the acquisition of surgical skills outside the high-stakes operating room environment. Three-dimensional printing has been used to create high-fidelity, immersive dry-lab models at a reasonable cost. Non-technical skills such as teamwork and decision-making have gained more attention. Structured surgical video review has been shown to improve surgical skills not only for trainees but also for qualified surgeons. Research and development in urologic surgical training has been active in the past 5 years. Despite these advances, there is still an unfulfilled need for a standardized surgical training program covering both technical and non-technical skills.
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Tan X, Li D, Jeong M, Yu T, Ma Z, Afat S, Grund KE, Qiu T. Soft Liver Phantom with a Hollow Biliary System. Ann Biomed Eng 2021; 49:2139-2149. [PMID: 33594636 PMCID: PMC8455397 DOI: 10.1007/s10439-021-02726-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
Hepatobiliary interventions are regarded as difficult minimally-invasive procedures that require experience and skills of physicians. To facilitate the surgical training, we develop a soft, high-fidelity and durable liver phantom with detailed morphology. The phantom is anatomically accurate and feasible for the multi-modality medical imaging, including computer tomography (CT), ultrasound, and endoscopy. The CT results show that the phantom resembles the detailed anatomy of real livers including the biliary ducts, with a spatial root mean square error (RMSE) of 1.7 ± 0.7 mm and 0.9 ± 0.2 mm for the biliary duct and the liver outer shape, respectively. The sonographic signals and the endoscopic appearance highly mimic those of the real organ. An electric sensing system was developed for the real-time quantitative tracking of the transhepatic puncturing needle. The fabrication method herein is accurate and reproducible, and the needle tracking system offers a robust and general approach to evaluate the centesis outcome.
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Affiliation(s)
- Xiangzhou Tan
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany.,Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, 72072, Tuebingen, Germany.,Department of General Surgery, Xiangya Hospital Central South University, Changsha, 410008, China
| | - Dandan Li
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany.,Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Moonkwang Jeong
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany
| | - Tingting Yu
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany.,Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Zhichao Ma
- Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany
| | - Saif Afat
- Department of Interventional and Diagnostic Radiology, University Hospital Tuebingen, 72072, Tuebingen, Germany
| | - Karl-Enrst Grund
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, 72072, Tuebingen, Germany
| | - Tian Qiu
- Cyber Valley Research Group, Institute of Physical Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569, Stuttgart, Germany. .,Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany.
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14
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Rowson B. 2020 Athanasiou ABME Student Awards. Ann Biomed Eng 2020. [DOI: 10.1007/s10439-020-02689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Suarez-Ibarrola R, Kriegmair M, Waldbillig F, Grüne B, Negassi M, Parupalli U, Schmitt A, Reiterer A, Müller C, Scheurer A, Baur S, Klein K, Fallert JA, Mündermann L, Yoganathan J, Probst M, Ihle P, Bobic N, Schumm T, Rehn H, Betke A, Graurock M, Forrer M, Gratzke C, Miernik A, Hein S. A novel endoimaging system for endoscopic 3D reconstruction in bladder cancer patients. MINIM INVASIV THER 2020; 31:34-41. [DOI: 10.1080/13645706.2020.1761833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | | | - Frank Waldbillig
- Department of Urology, University Hospital Mannheim, Mannheim, Germany
| | - Britta Grüne
- Department of Urology, University Hospital Mannheim, Mannheim, Germany
| | - Misgana Negassi
- Fraunhofer Institute for Physical Measurement Techniques IPM, Freiburg, Germany
- Department of Sustainable Systems Engineering INATECH, University of Freiburg, Freiburg, Germany
| | - Ujwala Parupalli
- Fraunhofer Institute for Physical Measurement Techniques IPM, Freiburg, Germany
- Department of Sustainable Systems Engineering INATECH, University of Freiburg, Freiburg, Germany
| | - Annette Schmitt
- Fraunhofer Institute for Physical Measurement Techniques IPM, Freiburg, Germany
- Department of Sustainable Systems Engineering INATECH, University of Freiburg, Freiburg, Germany
| | - Alexander Reiterer
- Fraunhofer Institute for Physical Measurement Techniques IPM, Freiburg, Germany
- Department of Sustainable Systems Engineering INATECH, University of Freiburg, Freiburg, Germany
| | | | | | - Stefan Baur
- QIT Systeme GmbH & Co. KG, Mannheim, Germany
| | | | | | | | | | | | | | - Neven Bobic
- Actuator Solutions, GmbH, Gunzenhausen, Germany
| | | | | | | | | | | | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Simon Hein
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
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Mathews DAP, Baird A, Lucky M. Innovation in Urology: Three Dimensional Printing and Its Clinical Application. Front Surg 2020; 7:29. [PMID: 32582760 PMCID: PMC7282341 DOI: 10.3389/fsurg.2020.00029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/23/2020] [Indexed: 12/14/2022] Open
Abstract
Three-dimensional (3D) printing allows rapid prototyping of novel equipment as well as the translation of medical imaging into tangible replicas of patient-specific anatomy. The technology has emerged as a versatile medium for innovation in medicine but with ever-expanding potential uses, does 3D printing represent a valuable adjunct to urological practice? We present a concise systematic review of articles on 3D printing within urology, outlining proposed benefits and the limitations in evidence supporting its utility. We review publications prior to December 2019 using guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Of 117 identified articles, 67 are included highlighting key areas of research as the use of patient-specific models for patient education, surgical planning, and surgical training. Further novel applications included printed surgical tools, patient-specific surgical guides, and bioprinting of graft tissues. We conclude to justify its adoption within standard practice, further research is required demonstrating that use of 3D printing can produce; direct and measurable improvements in patient experience, consistent evidence of superior surgical outcomes or simulation which surpasses existing means' both in fidelity and enhancement of surgical skills. Although exploration of 3D printing's urological applications remains nascent, the seemingly limitless scope for innovation and collaborative design afforded by the technology presents undeniable value as a resource and assures a place at the forefront of future advances.
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Affiliation(s)
- David A P Mathews
- University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | - Andrew Baird
- Aintree University Hospital, Liverpool, United Kingdom
| | - Marc Lucky
- Aintree University Hospital, Liverpool, United Kingdom
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