Ahmed Ghazi1,2, Rachel Melnyk2, Andrew J Hung3, Justin Collins4, Ashkan Ertefaie5, Patrick Saba2, Pratik Gurung1, Thomas Frye1, Hani Rashid1, Guan Wu1, Alex Mottrie6,7, Tony Costello8,9, Prokar Dasgupta10, Jean Joseph1. 1. Department of Urology, University of Rochester, Rochester, NY, USA. 2. Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA. 3. Department of Urology, University of Southern California, Los Angeles, CA, USA. 4. Division of Surgery and Interventional Science, University College London, London, UK. 5. Department of Biostatistics, University of Rochester, NY, USA. 6. Urological Department, OLV Hospital, Aalst, Belgium. 7. ORSI Academy, Melle, Belgium. 8. Department Departments of Surgery and Urology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Vic., Australia. 9. Australian Medical Robotics Academy (AMRA), Melbourne, Vic., Australia. 10. Chair of Urology, Life Sciences and Medicine, King's College London, London, UK.
Abstract
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.
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.
Authors: Daniel M Costello; Isabel Huntington; Grace Burke; Brooke Farrugia; Andrea J O'Connor; Anthony J Costello; Benjamin C Thomas; Philip Dundee; Ahmed Ghazi; Niall Corcoran Journal: J Robot Surg Date: 2021-09-03
Authors: Stefano Puliatti; Ahmed Eissa; Enrico Checcucci; Pietro Piazza; Marco Amato; Stefania Ferretti; Simone Scarcella; Juan Gomez Rivas; Mark Taratkin; Josè Marenco; Ines Belenchon Rivero; Karl-Friedrich Kowalewski; Giovanni Cacciamani; Ahmed El-Sherbiny; Ahmed Zoeir; Abdelhamid M El-Bahnasy; Ruben De Groote; Alexandre Mottrie; Salvatore Micali Journal: Asian J Urol Date: 2022-06-01