Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS).
#KidneyCancer
#kcsm
#uroonc
3D printing
high-fidelity
partial nephrectomy
polyvinyl alcohol
robot-assisted surgery
simulation
surgical education
training
validation
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
pubmed:
17
9
2020
medline:
8
10
2021
entrez:
16
9
2020
Statut:
ppublish
Résumé
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. 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. 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. 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. This perfused, procedural model offers an unprecedented realistic simulation platform, which incorporates objective, clinically relevant and procedure-specific performance metrics.
Types de publication
Journal Article
Multicenter Study
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
645-653Informations de copyright
© 2020 The Authors BJU International © 2020 BJU International Published by John Wiley & Sons Ltd.
Références
Reznick RK, MacRae H. Teaching surgical skills-changes in the wind. N Engl J Med 2006; 355: 2664-9
Rourke KF. From papayas to practice: surgical simulation and the future of urology training. Can Urol Assoc J 2015; 9: 37-8
Scott DJ, Dunnington GL. The new ACS/APDS skills curriculum: moving the learning curve out of the operating room. J Gastrointest Surg 2008; 12: 213-21
Culligan P, Gurshumov E, Lewis C et al. Predictive validity of a training protocol using a robotic surgery simulator. Female Pelvic Med Reconstr Surg 2014; 20: 48-51.
Ahmed K, Jawad M, Abboudi M et al. Effectiveness of procedural simulation in urology: a systematic review. J Urol 2011; 186: 26-34
Gilbody J, Prasthofer AW, Ho K et al. The use and effectiveness of cadaveric workshops in higher surgical training: a systematic review. Ann R Coll Surg Engl 2011; 93: 347-52
Ross HM, Simmang CL, Fleshman JW, Marcello PW. Adoption of laparoscopic colectomy: results and implications of ASCRS hands-on course participation. Surg Innov 2008; 15: 179-83
Villegas L, Schneider BE, Callery MP, Jones DB. Laparoscopic skills training. Surg Endosc 2003; 17: 1879-88
Larcher A, Muttin F, Peyronnet B et al. The learning curve for robot-assisted partial nephrectomy: impact of surgical experience on perioperative outcomes. Eur Urol 2018; 18: 30644-4
Cook DA, Zendejas B, Hamstra SJ, Hatala R, Brydges R. What counts as validity evidence? Examples and prevalence in a systematic review of simulation- based assessment. Adv Health Sci Educ 2014; 19: 233-50
Noureldin YA, Sweet RM. A call for a shift in theory and terminology for validation studies in urologic education. J Urol 2018; 199: 617-20
Li P, Jiang S, Yu Y, Yang J, Yang Z. Biomaterial characteristics and application of silicone rubber and PVA hydrogels mimicked in organ groups for prostate brachytherapy. J Mech Behav Biomed Mater 2015; 49: 220-34
Umale S, Deck C, Bourdet N et al. Experimental mechanical characterization of abdominal organs: liver, kidney & spleen. J Mech Behav Biomed Mater 2013; 17: 22-33
Kowalewski T, Comstock B, Sweet R et al. Measuring to improve: peer and crowd-sourced assessments of technical skill with robot-assisted radical prostatectomy. Eur Urol 2016; 69: 547-50
Ghazi A, Stone JJ, Candela B, Richards M, Joseph J. Simulated inanimate model for physical learning experience (SIMPLE) for robotic partial nephrectomy using a 3-D printed kidney model. J Urol 2015; 193(No. 4S Supplement): e778
Boës S, Ochsner G, Amacher R, Petrou A, Meboldt M, Schmid Daners M. Control of the fluid viscosity in a mock circulation. Artif Organs 2018; 42: 68-77
Farshad M, Barbezat M, Flueler P et al. Material characterization of the pig kidney in relation with the biomechanical analysis of renal trauma. J Biomech 1999; 32: 417-25
Melnyk R, Ezzat B, Belfast E et al. Mechanical and functional validation of a perfused, robot-assisted partial nephrectomy simulation platform using a combination of 3D printing and hydrogel casting. World J Urol 2020; 38: 1631-41
Carey JN, Minneti M, Leland HA et al. Perfused fresh cadavers: method for application to surgical simulation. Am J Surg 2015; 210: 179-87
Minneti M, Baker CJ, Sullivan ME. The development of a novel perfused cadaver model with dynamic vital sign regulation and real-world scenarios to teach surgical skills and error management. J Surg Educ 2018; 75: 820-7
Faure JP, Breque C, Danion J, Delpech PO, Oriot D, Richer JP. SIM Life: a new surgical simulation device using a human perfused cadaver. Surg Radiol Anat 2017; 39: 211-7
Childs BS, Manganiello MD, Korets R. Novel education and simulation tools in urologic training. Curr Urol Rep 2019; 28: 81
Yang B, Zeng Q, Yinghao S et al. A novel training model for laparoscopic partial nephrectomy using porcine kidney. J Endourol 2009; 23: 2029-33
Hung AJ, Shah SH, Dalag L, Shin D, Gill IS. Development and validation of a novel robotic procedure specific simulation platform: partial nephrectomy. J Urol 2015; 194: 520-6
Bruwaene SA, Schijven MP, Miserez M. Assessment of procedural skills using virtual simulation remains a challenge. J Surg 2014; 71: 654-61
Stefanidis D, Coker AP, Green JM, Casingal VP, Sindram D, Greene FL. Feasibility and value of a procedural workshop for surgery residents based on phase II of the APDS/ACS national skills curriculum. J Surg Educ 2012; 69: 735-9
Davis JW, Kamat A, Munsell M, Pettaway C, Pisters L, Matin S. Initial experience of teaching robot-assisted radical prostatectomy to surgeons-in-training: can training be evaluated and standardized? BJU Int 2010; 105: 1148-54
Hung A, Ng CK, Patil MB et al. Validation of a novel robotic-assisted partial nephrectomy surgical training model. BJU Int 2012; 110: 870-4
Larcher A, Naeyer GD, Turri F et al. The ERUS curriculum for robot-assisted partial nephrectomy: structure definition and pilot clinical validation. Eur Urol 2019; 75: 1023-31
Gallagher AG, Henn P. Simulation fidelity: more than experience and mere repetition? Stud Health Technol Inform 2014; 196: 128-34