Surgical Rehearsals Research Articles

How specific are patient-specific simulations? Analyzing the accuracy of 3D-printing and modeling to create patient-specific rehearsals for complex urological procedures.

In the field of urology, 3D printing and modeling are now regularly utilized to enhance pre-operative planning, surgical training, patient-specific rehearsals (PSR), and patient education and counseling. Widespread accessibility and affordability of such technologies necessitates development of quality control measures to confirm the anatomical accuracy of these tools. Herein, we present three methods utilized to evaluate the anatomical accuracy of hydrogel PSR, developed using 3D printing and molding for pre-operative surgical rehearsals, of robotic-assisted partial nephrectomy (RAPN) and percutaneous nephrolithotomy (PCNL). Virtual computer-aided designs (CADs) of patient anatomy were created through segmentation of patient CT scan images. Ten patient-specific RAPN and PCNL hydrogel models were CT scanned and segmented to create a corresponding model CAD. The part compare tool (3-matic, Materialize), point-to-point measurements, and Dice similarity coefficient (DSC) analyzed surface geometry, alignment, and volumetric overlap of each model component. Geometries of the RAPN parenchyma, tumor, artery, vein, and pelvicalyceal system lay within an average deviation of 2.5mm (DSC = 0.70) of the original patient geometry and 5mm (DSC = 0.45) of the original patient alignment. Similarly, geometries of the PCNL pelvicalyceal system and stone lay within 2.5mm (DSC = 0.6) and within 15mm (16% deviation) in alignment. This process enabled the refinement of our modeling process to fabricate anatomically accurate RAPN and PCNL PSR. As 3D printing and modeling continues to have a greater impact on patient care, confirming anatomical accuracy should be introduced as a quality control measure prior to use for patient care.

PD02-02 IMPACT OF PREOPERATIVE PATIENT-SPECIFIC SIMULATIONS FOR ROBOT-ASSISTED PARTIAL NEPHRECTOMY IN HIGHLY COMPLEX RENAL TUMORS: A PROPENSITY-MATCHED ANALYSIS OF COMPOSITE OUTCOMES

INTRODUCTION AND OBJECTIVE:Preoperative patient-specific simulations (PO-PSS), in the form of procedural platforms incorporating physical hydrogel organ models for surgical rehearsals and virtual p...

Technique for Rapid Hand Transplant Donor Procurement Through the Elbow.

Background: Hand and distal forearm allotransplantation has advanced over the last 20 years from experimental to a viable treatment option for bilateral upper extremity amputation. Despite widespread growth of this field, there are few technical reports that elaborate the details of donor arm procurement. This article details a technique for rapid donor procurement through the elbow for mid to distal forearm-level hand allograft procurement. Methods: Nine arm procurements were performed on deceased tissue-only donors provided by the local organ procurement organization, including two bilateral and five unilateral cases. Technique highlights include using a fishmouth incision through the lateral and medical epicondyles, identification of the neurovascular structures, and disarticulating the elbow joint. Results: Procuring through the elbow provides straightforward anatomy, bypasses the need to cut through bone, and allows tissue allotransplantation teams to achieve procurement, flushing, and packaging within 20 minutes. Conclusions: Procurement through the elbow is a simple procedure that streamlines the process for multi-organ donors by minimizing the time needed for hand allograft procurement. Team coordination and surgical rehearsals are essential for successful hand and upper extremity procurement and allotransplantation.

Preparation is the Only Shortcut You Need in Surgery: A Guide to Surgical Rehearsals for Hand and Upper Extremity Transplantation.

As upper extremity transplantation is becoming more accepted worldwide, the demand for a fresh tissue cadaveric training model for this procedure is increasing and necessary to assure surgical success. Surgical rehearsals can decrease operative time, improve technique, and reduce errors made on the actual day of surgery. The purpose of this article is to describe a method for surgical rehearsal of upper extremity transplantation using cadaveric specimens based on the clinical experience of an academic institution with an active transplantation program. The logistics of rehearsal setup, equipment, and modified version of procedural checklists are described.

Physician training protocol within the WEB Intrasaccular Therapy (WEB-IT) study

IntroductionThe WEB Intra-saccular Therapy (WEB-IT) trial is an investigational device exemption study to demonstrate the safety and effectiveness of the WEB device for the treatment of wide-neck bifurcation aneurysms. The...

V9-04 ROBOTIC PARTIAL NEPHRECTOMY IN THE SETTING OF IDIOPATHIC IVC OBSTRUCTION: A MULTIDISCIPLINARY APPROACH

using a novel three dimensional (3d) printing and silicone casting technology. METHODS: Using standard preoperative imaging, 3d reconstruction of renal parenchyma and tumor was performed to generate solid models suitable for rapid fabrication. Leveraging a novel prototyping process that utilizes 3d extrusion printing and subsequent polymer casting we generated pre-surgical models out of a silicone-based material. To determine how well these patientspecific models simulated actual operative experience, we compared enucleation times between model and actual tumor using the same robotic platform. For the final model, we performed 3d laser scans of both the enucleated model and tumor comparing their spatial characteristics. All surgical rehearsals were performed prior to the actual procedure. RESULTS: We generated patient-specific pre-surgical models for 3 patients. R.E.N.A.L. nephrometry scoring for the pre-surgical models was 7a, 8p, 8a and tumor sizes were 3.5x3.4x3.5 cm, 4.1x3.8x3.5 cm, and 1.5x1.4x1.4 cm. Time of enucleation was similar between the patient-specific pre-surgical models and the actual surgery (6:24 vs. 5:58, 3:11 vs. 3:43, 4:55 vs. 6:09 mins). For case #3, the surgical model enucleation volume measured 6.4 mm3 and the actual excised specimen 12.8 mm3. A 3d-reconstructed visual overlay demonstrated a high level of coherence in the shape of the excised tumor and allowed measurement of the difference in the volume of excised normal renal parenchyma between the model and the actual patient specimen. CONCLUSIONS: We have developed a patient-specific presurgical simulation for robotic partial nephrectomy. Our model provides accurate representation of enucleation time and volume of resected tissue. This highly reproducible simulation platform has the potential to alter surgical decision-making and allow for preoperative rehearsal in complex cases. Furthermore it may become a valuable tool for resident training.

Head-mounted display system for microneurosurgery.

Advances in video technology have enabled the incorporation of high-resolution electronic imaging of an operative field during microneurosurgical and endoscopic procedures. While current video-based monoscopic camera and monitor systems produce an excellent image, the third dimension is lacking and the operative field and image are at different locations. We describe a head-mounted display (HMD) that allows the surgical team to simultaneously visualize a surgical field and a high-resolution magnified stereoscopic image which includes a picture-in-picture capability. Stereoscopic HMDs should result in improved efficiency and safety in both endoscopic and open microsurgical procedures. Additional uses relate to surgical training and operative rehearsals.