Friday, June 17, 20224:00 PM - 5:00 PM MSPP01 Presentation Time: 4:00 PM: A Feasibility Study on Utilizing Cadaveric Models at a Network of Brachytherapy Research and Training Centers to Encourage Development and Widespread Use of Novel Robotic Bladder Cancer Brachytherapy Techniques

Abstract

<h3>Purpose</h3> This feasibility study outlines a proof-of-concept model – the Houston Methodist Institute for Technology, Innovation & Education (MITIE) – for the use of cadaveric models at research centers to encourage development and training of novel robotic brachytherapy techniques, thereby expediting the incorporation of brachytherapy into the standard of care for muscle-invasive bladder cancer (MIBC). <h3>Materials and Methods</h3> Catheter insertion sites were marked on a male cadaver, and the da Vinci Surgical System(R) (Intuitive Surgical, Inc., Sunnyvale, CA) was docked. A modified catheter-needle system was assembled since pre-assembled bladder-specific catheter-needle systems are not compatible with all brachytherapy afterloaders. Closed-end catheters were inserted into 17-gauge curved needles. The first catheter was placed into the right lateral hypogastric abdominal wall, through the bladder dome wall, and out the opposing side. A single plane implant was completed with 1 cm spacing with the two other catheters (Figure 1a). Catheters were secured with nylon retaining buttons (Figure 1b). A CT simulation scan confirmed placement and a plan was developed for simulated brachytherapy delivery (Figure 1c). <h3>Results</h3> Cadaveric models enable physicians to develop new brachytherapy procedures in a controlled and simulated surgical environment without affecting operative time. Physicians can gain familiarity with the procedure and practice alterations to surgical equipment, including the catheter-needle system, which may prevent complications peri- and postoperatively. The proof-of-concept trial in MITIE shows how research and training centers can serve as incubators for the development of brachytherapy techniques. With a network of these centers, experts across the country can collaborate to test new techniques on cadaveric models and accelerate developments in bladder brachytherapy. This network would provide training opportunities for physicians, especially residents, which can familiarize physicians with brachytherapy techniques, promoting their use and providing clinical data to support these techniques as a new standard of care. Currently, institutes like MITIE are limited in number, necessitating travel and coordination of attending and resident physicians' schedules. Although an expanded network of these institutes would alleviate this issue, these training centers are associated with high operating costs, including the acquisition costs and high turnover rate required of cadaveric training models. Therefore, cost may impede scalability and must be considered alongside the benefits of establishing a widespread network of research and training programs for brachytherapy. <h3>Conclusions</h3> Robotic brachytherapy is a rarely utilized, minimally invasive treatment modality for MIBC. Innovation-focused facilities with cadaveric models can provide simulated surgical environments for the research, development, and training of robotic brachytherapy techniques and applicators, accelerating the acceptance of brachytherapy as the standard of care for MIBC.