Publications by authors named "Ahmed Ghazi"

58 Publications

Comparison of Multi-Parametric MRI of the Prostate to 3D Prostate Computer Aided Designs and 3D-Printed Prostate Models for Pre-Operative Planning of Radical Prostatectomies: A Pilot Study.

Urology 2021 Sep 5. Epub 2021 Sep 5.

University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York. Electronic address:

Objective: To evaluate the use of 3D computed aided designs and 3D-printed models as pre-operative planning tools for urologists, in addition to radiologist interpreted mp-MRIS, prior to radical prostatectomy procedures.

Methods: Ten patients with biopsy-positive lesions detected on mp-MRI were retrospectively selected. Radiologists identified lesion locations using a Prostate Imaging-Reporting and Data System (PI-RADS) map and segmented the prostate, lesion(s), and surrounding anatomy to create 3D-CADs and 3D-printed models for each patient. Six uro-oncologists randomly reviewed three modalities (mp-MRI, 3D-CAD, and 3D-printed models) for each patient and identified lesion locations which were graded for accuracy against the radiologists' answers. Questionnaires assessed decision confidence, ease-of-interpretation, and usefulness for preoperative planning for each modality.

Results: Using 3D-CADs and 3D-printed models compared to mp-MRI, urologists were 2.4x and 2.8x more accurate at identifying the lesion(s), 2.7x and 3.2x faster, 1.6x and 1.63x more confident, and reported it was 1.6x and 1.7x easier to interpret. 3D-CADs and 3D-printed models were reported significantly more useful for overall pre-operative planning, identifying lesion location(s), determining degree of nerve sparing, obtaining negative margins, and patient counseling. Sub-analysis showed 3D-printed models demonstrated significant improvements in ease-of-interpretation, speed, usefulness for obtaining negative margins, and patient counseling compared to 3D-CADs.

Conclusion: 3D-CADs and 3D-printed models are useful adjuncts to mp-MRI in providing urologists with more practical, accurate, and efficient pre-operative planning.
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http://dx.doi.org/10.1016/j.urology.2021.08.031DOI Listing
September 2021

A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education.

J Robot Surg 2021 Sep 3. Epub 2021 Sep 3.

Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.

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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http://dx.doi.org/10.1007/s11701-021-01302-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415702PMC
September 2021

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

World J Urol 2021 Aug 14. Epub 2021 Aug 14.

Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA.

Purpose: 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).

Methods: 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.

Results: Geometries of the RAPN parenchyma, tumor, artery, vein, and pelvicalyceal system lay within an average deviation of 2.5 mm (DSC = 0.70) of the original patient geometry and 5 mm (DSC = 0.45) of the original patient alignment. Similarly, geometries of the PCNL pelvicalyceal system and stone lay within 2.5 mm (DSC = 0.6) and within 15 mm (16% deviation) in alignment. This process enabled the refinement of our modeling process to fabricate anatomically accurate RAPN and PCNL PSR.

Conclusion: 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.
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http://dx.doi.org/10.1007/s00345-021-03797-0DOI Listing
August 2021

Design and Implementation of an Emergency Undocking Curriculum for Robotic Surgery.

Simul Healthc 2021 Aug 11. Epub 2021 Aug 11.

From the Simulation Innovation Lab (R.M., P.S., T.H., K.C., A.E.G.) and Department of Urology (P.M., P.R., G.W., J.C., H.R., J.V.J., A.E.G.), University of Rochester Medical Center (URMC), Rochester, NY.

Introduction: Current training for robotic surgery crisis management, specifically emergency robotic undocking protocol (ERUP), remains limited to anecdotal experience. A curriculum to impart the skills and knowledge necessary to recognize and complete a successful ERUP was developed using an education approach then evaluated.

Methods: Baseline knowledge and confidence regarding ERUP were established for 5 robotic teams before completing 2 full-immersion simulations separated by an online self-paced learning module. In each simulation, teams operated on a perfused hydrogel model and were tasked to dissect a retroperitoneal tumor abutting a major vessel. During vascular pedicle ligation, a major vascular bleed and nonrecoverable robotic fault were remotely induced, necessitating ERUP with open conversion. After the simulation, participants completed surgery task load index (cognitive load assessment) and realism surveys. Weighted checklists scored participants' actions during each simulation. Surgical metrics including estimated blood loss, time to control bleeding, and undocking time were recorded. Curriculum retention was assessed by repeating the exercise at 6 months.

Results: Participants experienced high levels of cognitive demand and agreed that the simulation's realism and stress mimicked live surgery. Longitudinal analysis showed significant knowledge (+37.5 points, p = 0.004) and confidence (+15.3 points, p < 0.001) improvements from baseline to completion. Between simulations, checklist errors, undocking time, and estimated blood loss decreased (38→17, -40 seconds, and -500 mL, respectively), whereas action scores increased significantly (+27 points, p = 0.008). At 6 months, insignificant changes from curriculum completion were seen in knowledge (-4.8 points, p = 0.36) and confidence (+3.7 points, p = 0.1).

Conclusions: This simulation-based curriculum successfully improves operative team's confidence, knowledge, and skills required to manage robotic crisis events.
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http://dx.doi.org/10.1097/SIH.0000000000000596DOI Listing
August 2021

Utilising an Accelerated Delphi Process to Develop Guidance and Protocols for Telepresence Applications in Remote Robotic Surgery Training.

Eur Urol Open Sci 2020 Dec 6;22:23-33. Epub 2020 Nov 6.

Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK.

Context: The role of robot-assisted surgery continues to expand at a time when trainers and proctors have travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic.

Objective: To provide guidance on setting up and running an optimised telementoring service that can be integrated into current validated curricula. We define a standardised approach to training candidates in skill acquisition via telepresence technologies. We aim to describe an approach based on the current evidence and available technologies, and define the key elements within optimised telepresence services, by seeking consensus from an expert committee comprising key opinion leaders in training.

Evidence Acquisition: This project was carried out in phases: a systematic review of the current literature, a teleconference meeting, and then an initial survey were conducted based on the current evidence and expert opinion, and sent to the committee. Twenty-four experts in training, including clinicians, academics, and industry, contributed to the Delphi process. An accelerated Delphi process underwent three rounds and was completed within 72 h. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as ≥80% agreement.

Evidence Synthesis: There was 100% consensus regarding an urgent need for international agreement on guidance for optimised telepresence. Consensus was reached in multiple areas, including (1) infrastructure and functionality; (2) definitions and terminology; (3) protocols for training, communication, and safety issues; and (4) accountability including ethical and legal issues. The resulting formulated guidance showed good internal consistency among experts, with a Cronbach alpha of 0.90.

Conclusions: Using the Delphi methodology, we achieved international consensus among experts for development and content validation of optimised telepresence services for robotic surgery training. This guidance lays the foundation for launching telepresence services in robotic surgery. This guidance will require further validation.

Patient Summary: Owing to travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic, development of remote training and support via telemedicine is becoming increasingly important. We report a key opinion leader consensus view on a standardised approach to telepresence.
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http://dx.doi.org/10.1016/j.euros.2020.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317899PMC
December 2020

Validity of a patient-specific percutaneous nephrolithotomy (PCNL) simulated surgical rehearsal platform: impact on patient and surgical outcomes.

World J Urol 2021 Jun 24. Epub 2021 Jun 24.

Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.

Introduction: Simulators provide a safe method for improving surgical skills without the associated patient risks. Advances in rapid prototyping technology have permitted the reconstruction of patient imaging into patient-specific surgical simulations that require advanced expertise, potentially continuing the learning curve.

Objectives: To evaluate the impact of preoperative high-fidelity patient-specific percutaneous nephrolithotomy hydrogel simulations on surgical and patient outcomes.

Materials And Methods: Between 2016 and 2017, a fellowship-trained endourologist performed 20 consecutive percutaneous nephrolithotomy procedures at an academic referral center. For the first ten patients, only standard review of patient imaging was completed. For the next ten patients, patient imaging was utilized to fabricate patient-specific models including pelvicalyceal system, kidney, stone, and relevant adjacent structures from hydrogel. The models were tested to confirm anatomic accuracy and material properties similar to live tissue. Full procedural rehearsals were completed 24-48 h before the real case. Surgical metrics and patient outcomes from both groups (rehearsal vs. standard) were compared.

Results: Significant improvements in mean fluoroscopy time, percutaneous needle access attempts, complications, and additional procedures were significantly lower in the rehearsal group (184.8 vs. 365.7 s, p < 0.001; 1.9 vs. 3.6 attempts, p < 0.001; 1 vs. 5, p < 0.001; and 1 vs. 5, p < 0.001, respectively). There were no differences in stone free rates, mean patient age, body mass index, or stone size between the two groups.

Conclusion: This study demonstrates that patient-specific procedural rehearsal is effective reducing the experience curve for a complex endourological procedure, resulting in improved surgical performance and patient outcomes.
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http://dx.doi.org/10.1007/s00345-021-03766-7DOI Listing
June 2021

Role of paracervical block in reducing postoperative pain after laparoscopic hysterectomy: A systematic reivew and meta-analysis of randomized controlled trials.

J Gynecol Obstet Hum Reprod 2021 May 10;50(9):102156. Epub 2021 May 10.

Department of Obstetrics and Gynecology, Faculty of Medicine, Al Azhar University for Girls, Cairo, Egypt.

Objective: We aimed to perform a systematic review and meta-analysis in order to evaluate the effect of paracervical anesthetic block among women undergoing laparoscopic hysterectomy.

Methods: A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus during January 2021. We selected randomized clinical trials (RCTs) compared paracervical anesthetic block versus normal saline (control group) among women undergoing laparoscopic hysterectomy. We pooled the continuous data as mean difference (MD) and dichotomous data as risk ratio (RR) with the corresponding 95% confidence intervals using Revman software. Our primary outcome was pain scores evaluated by visual analog scale (VAS) at 30 min and 1 hour. Our secondary outcomes were postoperative additional opioids requirement and length of hospital stay.

Results: Three RCTs met our inclusion criteria with a total number of 233 patients. We found that paracervical anesthetic block was linked to a significant reduction in VAS pain score at 30 min and 1 hour post-hysterectomy (MD= -2.13, 95% CI [-3.09, -1.16], p>0.001 & MD= -1.87, 95% CI [-3.22, -0.52], p = 0.006). There was a significant decrease in additional opioids requirement postoperatively among paracervical anesthetic block group in comparison with control group (p = 0.002). No significant difference was found between both groups regarding the length of hospital stay.

Conclusion: Paracervical anesthetic block is effective in reducing postoperative pain after laparoscopic hysterectomy with decrease in opioids administration postoperatively.
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http://dx.doi.org/10.1016/j.jogoh.2021.102156DOI Listing
May 2021

Ethical implications of AI in robotic surgical training: A Delphi consensus statement.

Eur Urol Focus 2021 Apr 30. Epub 2021 Apr 30.

Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London.

Context: As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them.

Objectives: To provide ethical guidance on developing narrow AI applications for surgical training curricula. We define standardised approaches to developing AI driven applications in surgical training that address current recognised ethical implications of utilising AI on surgical data. We aim to describe an ethical approach based on the current evidence, understanding of AI and available technologies, by seeking consensus from an expert committee.

Evidence Acquisition: The project was carried out in 3 phases: (1) A steering group was formed to review the literature and summarize current evidence. (2) A larger expert panel convened and discussed the ethical implications of AI application based on the current evidence. A survey was created, with input from panel members. (3) Thirdly, panel-based consensus findings were determined using an online Delphi process to formulate guidance. 30 experts in AI implementation and/or training including clinicians, academics and industry contributed. The Delphi process underwent 3 rounds. Additions to the second and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement.

Evidence Synthesis: There was 100% response from all 3 rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of >0.8. There was 100% consensus that there is currently a lack of guidance on the utilisation of AI in the setting of robotic surgical training. Consensus was reached in multiple areas, including: 1. Data protection and privacy; 2. Reproducibility and transparency; 3. Predictive analytics; 4. Inherent biases; 5. Areas of training most likely to benefit from AI.

Conclusions: Using the Delphi methodology, we achieved international consensus among experts to develop and reach content validation for guidance on ethical implications of AI in surgical training. Providing an ethical foundation for launching narrow AI applications in surgical training. This guidance will require further validation.

Patient Summary: As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them.In this paper we provide guidance on ethical implications of AI in surgical training.
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http://dx.doi.org/10.1016/j.euf.2021.04.006DOI Listing
April 2021

Application of IRIS Three-Dimensional Anatomical Models As Preoperative Surgical Planning Tools in the Management of Localized Renal Masses.

J Endourol 2021 03 23;35(3):383-389. Epub 2021 Feb 23.

Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.

The use of volume-rendered images is gaining popularity in the surgical planning for complex procedures. IRIS™ is an interactive software that delivers three-dimensional (3D) virtual anatomical models. We aimed to evaluate the preoperative clinical utility of IRIS for patients with ≤T2 localized renal tumors who underwent either partial nephrectomy (PN) or radical nephrectomy (RN). Six urologists (four faculty and two trainees) reviewed CT scans of 40 cases over 2 study phases, using conventional two-dimensional (2D) CT alone (Phase-I), followed by the CT + IRIS 3D model (Phase-II). After each review, surgeons reported their decision on performing a PN or an RN and rated (Likert scale) their confidence in completing the procedure as well as how the imaging modality influenced specific procedural decisions. Modifications to the choice of procedure and confidence in decisions between both phases were compared for the same surgeon. Concordance between surgeons was also evaluated. A total of 462 reviews were included in the analysis (231 in each phase). In 64% (95% CI: 58-70%) of reviews, surgeons reported that IRIS achieved a better spatial orientation, understanding of the anatomy, and offered additional information compared with 2D CT alone. IRIS impacted the planned procedure in 20% of the reviews (3.5% changed decision from PN to RN and 16.5% changed from RN to PN). In the remaining 80% of reviews, surgeons' confidence increased from 78% (95% CI: 72-84%) with 2D CT, to 87% (95% CI: 82-92%) with IRIS ( = 0.02); this confidence change was more pronounced in cases with a high RENAL score ( = 0.009). In 99% of the reviews, surgeons rated that the IRIS accurately represented the anatomical details of all kidney components. Application of IRIS 3D models could influence the surgical decision-making process and improve surgeons' confidence, especially for robot-assisted management of complex renal tumors.
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http://dx.doi.org/10.1089/end.2020.0405DOI Listing
March 2021

Implementation of an E-Learning Academic Elective for Hands-On Basic Surgical Skills to Supplement Medical School Surgical Education.

J Surg Educ 2021 Jul-Aug;78(4):1164-1174. Epub 2020 Dec 10.

Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, Rochester, New York. Electronic address:

Objective: To examine the feasibility and utility of a completely online surgical skills elective for undergraduate medical students.

Design: The fully asynchronous, one-week, online learning elective addressed surgical instrument identification, knot tying, and suturing. Tools for knowledge acquisition and self-practice were outlined and individualized performance feedback on technical skills performance was incorporated from peers and experts through video conference.

Setting: University of Rochester School of Medicine & Dentistry, Rochester, NY.

Participants: A total of 86 third- and fourth-year medical students enrolled and successfully completed the elective.

Results: At elective completion, nearly all students met their course objectives and significantly increased their confidence in surgical instrument identification, knot tying, and suturing. Objective measures of student knowledge and technical skills acquisition were overwhelmingly positive, and faculty and students were very satisfied with providing and receiving performance feedback. Students reported that expert feedback was more useful than peer feedback, and more students than faculty reported that the online modality was equivalent to an in-person session for performance review.

Conclusions: This innovative online surgical skills elective improved undergraduate medical student confidence, knowledge, and skillset with surgical instrument identification, knot tying, and suturing while also facilitating effective expert feedback on individual performance.
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http://dx.doi.org/10.1016/j.jsurg.2020.11.014DOI Listing
June 2021

Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement.

BJU Int 2021 06 10;127(6):729-741. Epub 2021 Mar 10.

Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Objective: Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic.

Methods: We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways.

Results: Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites.

Conclusion: Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.
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http://dx.doi.org/10.1111/bju.15299DOI Listing
June 2021

Evolving robotic surgery training and improving patient safety, with the integration of novel technologies.

World J Urol 2021 Aug 6;39(8):2883-2893. Epub 2020 Nov 6.

Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK.

Introduction: Robot-assisted surgery is becoming increasingly adopted by multiple surgical specialties. There is evidence of inherent risks of utilising new technologies that are unfamiliar early in the learning curve. The development of standardised and validated training programmes is crucial to deliver safe introduction. In this review, we aim to evaluate the current evidence and opportunities to integrate novel technologies into modern digitalised robotic training curricula.

Methods: A systematic literature review of the current evidence for novel technologies in surgical training was conducted online and relevant publications and information were identified. Evaluation was made on how these technologies could further enable digitalisation of training.

Results: Overall, the quality of available studies was found to be low with current available evidence consisting largely of expert opinion, consensus statements and small qualitative studies. The review identified that there are several novel technologies already being utilised in robotic surgery training. There is also a trend towards standardised validated robotic training curricula. Currently, the majority of the validated curricula do not incorporate novel technologies and training is delivered with more traditional methods that includes centralisation of training services with wet laboratories that have access to cadavers and dedicated training robots.

Conclusions: Improvements to training standards and understanding performance data have good potential to significantly lower complications in patients. Digitalisation automates data collection and brings data together for analysis. Machine learning has potential to develop automated performance feedback for trainees. Digitalised training aims to build on the current gold standards and to further improve the 'continuum of training' by integrating PBP training, 3D-printed models, telementoring, telemetry and machine learning.
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http://dx.doi.org/10.1007/s00345-020-03467-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405494PMC
August 2021

Utilizing 3D Printing and Hydrogel Casting for the Development of Patient-Specific Rehearsal Platforms for Robotic Assisted Partial Nephrectomies.

Urology 2021 Jan 28;147:317. Epub 2020 Oct 28.

University of Rochester Medical Center, Division Department of Urology, 601 Elmwood Ave, Rochester, NY.

Background: Three-dimensional (3D) printing technology has been utilized to create patient-specific (PS) replicas as visual aids for surgical planning. However, they cannot recreate the operative experience due to a lack of realistic tissue characteristics.

Objectives: Develop anatomically accurate, realistic, PS partial nephrectomy platforms suitable for pre-operative surgical rehearsals using 3D-printing and hydrogel casting.

Material: Patient CT scans were segmented into a computer-aided design (CAD) file and used to create injection casts. Kidney and tumor casts along with hollow vascular and urinary structures were 3D-printed. The hilar structures and tumor were registered into the kidney cast, injected with poly-vinyl alcohol (PVA) hydrogel, and processed to create the kidney phantom. Mechanical and functional testing protocols were completed to confirm that the properties of PVA matched the live tissue. Anatomical accuracy was confirmed by CT scanning the phantom and creating another CAD, which was compared to the original patient CAD. Full-procedural PS rehearsals were completed 24-48 hours prior to their respective live surgeries. Clinically relevant metrics (warm ischemia time, estimated blood loss, and positive surgical margins) from each rehearsal and live case were compared using a Wilcoxon-rank sum test.

Results: The 7%-3freeze/thaw PVA best recreated the mechanical and functional properties of porcine kidneys, while anatomical verification showed ≤1 mm deviation of the kidney and tumor from the patient anatomy and ≤3 mm for the hilar structures. PS rehearsal platforms were fabricated using these methods for 8 patients (average tumor size 5.92 cm and nephrometry score 9.8). A positive correlation was found for warm ischemia time and estimated blood loss between rehearsals and live surgeries.

Conclusion: This reproducible method shows high anatomical accuracy, realistic tissue properties, and translational effects between rehearsals and live surgery. To determine the effects on patient outcomes, future studies will compare the impact of completing a pre-operative rehearsal vs standard surgical preparation.
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http://dx.doi.org/10.1016/j.urology.2020.10.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785697PMC
January 2021

Accuracy of Touch-Based Registration During Robotic Image-Guided Partial Nephrectomy Before and After Tumor Resection in Validated Phantoms.

J Endourol 2021 03 11;35(3):362-368. Epub 2020 Nov 11.

Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Image-guided surgery (IGS) allows for accurate, real-time localization of subsurface critical structures during surgery. No prior IGS systems have described a feasible method of intraoperative reregistration after manipulation of the kidney during robotic partial nephrectomy (PN). We present a method for seamless reregistration during IGS and evaluate accuracy before and after tumor resection in two validated kidney phantoms. We performed robotic PN on two validated kidney phantoms-one with an endophytic tumor and one with an exophytic tumor-with our IGS system utilizing the da Vinci Xi robot. Intraoperatively, the kidney phantoms' surfaces were digitized with the da Vinci robotic manipulator via a touch-based method and registered to a three-dimensional segmented model created from cross-sectional CT imaging of the phantoms. Fiducial points were marked with a surgical marking pen and identified after the initial registration using the robotic manipulator. Segmented images were displayed via picture-in-picture in the surgeon console as tumor resection was performed. After resection, reregistration was performed by reidentifying the fiducial points. The accuracy of the initial registration and reregistration was compared. The root mean square (RMS) averages of target registration error (TRE) were 2.53 and 4.88 mm for the endophytic and exophytic phantoms, respectively. IGS enabled resection along preplanned contours. Specifically, the RMS averages of the normal TRE over the entire resection surface were 0.75 and 2.15 mm for the endophytic and exophytic phantoms, respectively. Both tumors were resected with grossly negative margins. Point-based reregistration enabled instantaneous reregistration with minimal impact on RMS TRE compared with the initial registration (from 1.34 to 1.70 mm preresection and from 1.60 to 2.10 mm postresection). We present a novel and accurate registration and reregistration framework for use during IGS for PN with the da Vinci Xi surgical system. The technology is easily integrated into the surgical workflow and does not require additional hardware.
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http://dx.doi.org/10.1089/end.2020.0363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987368PMC
March 2021

See Like an Expert: Gaze-Augmented Training Enhances Skill Acquisition in a Virtual Reality Robotic Suturing Task.

J Endourol 2021 03 21;35(3):376-382. Epub 2021 Jan 21.

Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.

The da Vinci Skills Simulator (DVSS) is an effective platform for robotic skills training. Novel training methods using expert gaze patterns to guide trainees have demonstrated superiority to traditional instruction. Portable head-mounted eye-trackers (HMET) offer the opportunity for eye tracking technology to enhance surgical robotic simulation training. To evaluate if training guided by expert gaze patterns can improve trainee performance over standard movement training techniques during robotic simulation. Medical students were recruited and randomized into gaze training (GT,  = 9) and movement training (MT,  = 8) groups. First, the participants reviewed an instructional video, with the GT group emulating expert gaze patterns and the MT group ( = 8) standard movement-based instruction. Training consisted of 10 repetitions of "Suture Sponge 3" on the DVSS while wearing HMET; the first three repetitions were followed by group-appropriate video coaching (gaze movement feedback), while the remaining repetitions were without feedback. Finally, two multitasking repetitions with a secondary bell-counting task were completed. Primary outcomes included DVSS scores during training and multitasking. Secondary outcomes included metrics collected from the HMET (gaze patterns and gaze entropy). Total score, efficiency, and penalties improved significantly over the training in both groups; the GT group achieved higher scores on every attempt. Total scores in the GT group were higher than the MT group postvideo review (20.3 ± 21.8 3.0 ± 6.2,  = 0.047), after coaching repetitions (61.8 ± 18.8 30.1 ± 26.2,  = 0.01), and at the last training attempt (73.0 ± 16.5 63.1 ± 17.4,  = 0.247). During multitasking, the GT group maintained higher total scores (75 ± 10.1 63.3 ± 15.3,  = 0.01), efficiency (86.3 ± 7.4 77.4 ± 11.2,  = 0.009), and superior secondary task performance (error: 6.3% ± 0.06 10.7% ± 0.11,  = 0.20). Gaze entropy (cognitive-load indicator) and gaze pattern analysis showed similar trends. Gaze-augmented training leads to more efficient movements through adoption of expert gaze patterns that withstand additional stressors.
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http://dx.doi.org/10.1089/end.2020.0445DOI Listing
March 2021

The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory.

J Sex Med 2020 11 15;17(11):2299-2306. Epub 2020 Sep 15.

Department of Urology, University of Rochester Medical Center, Rochester, NY, USA; Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA. Electronic address:

Background: There is a significant need for a non-biohazardous, educational platform to equip and maintain the surgical skills required by urology trainees and low-volume implanters for inflatable penile prosthetic (IPP) placement.

Aim: To design and develop an anatomic, hydrogel-based simulation platform for training and evaluate IPP placement using modern education theory.

Methods: The backward design concept was used as a framework in the design and development of an IPP simulation platform. Steps included delineating requirements from a physicians' perspective, translating requirements into engineering tasks (deliverables), developing a prototype, and pilot validation. Using a combination of 3-dimensional printing and hydrogel casting, a genitourinary tract model was constructed to replicate the appropriate steps of IPP placement guided by expert feedback. Full-immersion IPP simulations were performed through both infrapubic and penoscrotal approaches by 4 expert surgeons under operative conditions. Questionnaires evaluating the simulation's realism, value as a training tool, and further recommendations were completed.

Outcomes: Using backward design educational pedagogy, a high-fidelity, full-procedural IPP simulation was fabricated and verified as an adequate educational tool for training and assessment.

Results: An expert consensus on the anatomic landmarks, steps and substeps, instruments, and errors to be included in the model was reached using a hierarchical task analysis and was successfully translated into a prototype hydrogel model. Experts performed all appropriate steps of IPP surgery and rated the simulation highly in terms of its realism and value as a training tool. On average, experts agreed that the model could function as a training tool, assessment tool, prerequisite for IPP accreditation, and requirement before live surgery. Experts stated they would have their trainees ideally complete an average of 1.75 models before live surgical training. All experts believed an operative checklist would be an ideal assessment tool. Witthaus MW, Saba P, Melnyk R, et al. The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory. J Sex Med 2020;17:2299-2306.
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http://dx.doi.org/10.1016/j.jsxm.2020.08.003DOI Listing
November 2020

Looking Beyond the Horizon: Patient-Specific Rehearsals for Complex Liver Surgeries With 3D Printed Model.

Ann Surg 2021 01;273(1):e28-e30

Department of Surgery, Division of Transplantation and Hepatobiliary Surgery, University of Rochester, Rochester, New York.

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http://dx.doi.org/10.1097/SLA.0000000000004491DOI Listing
January 2021

Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS).

BJU Int 2021 06 6;127(6):645-653. Epub 2020 Oct 6.

Department of Urology, University of Rochester, Rochester, NY, USA.

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.
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http://dx.doi.org/10.1111/bju.15246DOI Listing
June 2021

Development of a high-fidelity coronary artery bypass graft training platform using 3-dimensional printing and hydrogel molding.

J Thorac Cardiovasc Surg 2021 04 24;161(4):e291-e293. Epub 2020 Jun 24.

Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, NY.

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http://dx.doi.org/10.1016/j.jtcvs.2020.05.106DOI Listing
April 2021

Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies.

J Endourol 2020 10 28;34(10):1088-1094. Epub 2020 Aug 28.

Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA.

Despite the adoption of robotic donor nephrectomy, the steep learning curve of robotic recipient transplantation has hindered the implementation of a complete robot-assisted kidney transplantation (RAKT). We sought to develop a high-fidelity perfused full immersion nonbiohazardous platform for RAKT simulation training. A three-dimensional (3D) computer-aided design (CAD) model consisting of a kidney, pelvicaliceal system, renal artery, and vein was created from a CT scan of a donor patient. 3D printed casts designed from the CAD model were injected with various polyvinyl alcohol hydrogel formulations to fabricate an anatomical kidney phantom and surrounding abdominal cavity. The process was repeated using a recipient's CT scan to create the recipient pelvic model containing a bony pelvis, pelvic musculature, iliac arteries and veins, and bladder. Donor and recipient models each contained structures to simulate the perfused vascular and ureterovesical anastomosis. A board-certified transplant surgeon completed a robotic training curriculum, including four RAKT simulation procedures, from procurement of the donor kidney to final retroperitonealization. Metrics from the simulations (e.g., arterial, venous, ureterovesical, and total anastomosis times) were recorded and compared with surgical times from published data. The average time for the nephrectomies was 67.33 (±31.58) minutes. The average total anastomosis time was 60.85 (±9.73) minutes with 20.37 (±3.87), 20.17 (±4) and 15.1 (±2.35) minutes for arterial, venous, and ureterovesical anastomosis, respectively. The recorded arterial and venous anastomosis times were within published times for competency (Δ = 2.47 and Δ = 2.87, respectively), whereas the uterovesical time was within the mastery range (Δ = 0.45). Using a combination of 3D printing and hydrogel casting technologies, a high fidelity perfused full-immersion nonbiohazardous simulation platform for RAKT was developed. The utilization of this platform has the potential to replace the early cases in a learning curve while decreasing the barriers to utilization for transitioning transplant surgeons.
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http://dx.doi.org/10.1089/end.2020.0441DOI Listing
October 2020

Cadaveric Laboratory Simulation Training of Male Stress Urinary Incontinence Treatment Improves Trainee Knowledge and Confidence.

Urology 2020 Sep 20;143:48-54. Epub 2020 Jun 20.

Boston University Medical Center, Boston, MA.

Objective: To assess whether a focused, simulation training course can improve trainee surgical knowledge and confidence in the treatment of male stress urinary incontinence.

Materials And Methods: Urology residents participated in a prosthetic education course as part of the 2018 SUPS and SMSNA annual meeting. The course included didactic lectures and a hands-on cadaveric laboratory. Participants completed questionnaires before and after the lab (2 weeks and 6 months) to assess procedural knowledge and confidence. Analysis of lab responses was performed using the Wilcoxon signed rank test for matched pairs.

Results: Thirty-two residents (median age 29, range 27-34) participated in the course. The majority were postgraduate year 4 (63%) or postgraduate year 5 (20%). Most participants reported minimal AUS or sling experience with 50% and 94% reporting less than 5 cases, respectively. Overall score from the knowledge assessment improved significantly between the pre-lab versus 2-week post-lab (P = .02) and pre-lab versus 6-month post-lab (P = .01). Similarly, procedural confidence improved between pre-lab vs 2-week post-lab (P < .001) and pre-lab versus 6-month post-lab (P < .001). Knowledge and confidence assessments were not different between year of residency training or pre-lab experience.

Conclusions: Simulation training improves knowledge and confidence in prosthetic surgery for male stress incontinence. In the current climate of reduced exposure and limited availability of prosthetic educators, simulation courses can provide much needed educational value.
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http://dx.doi.org/10.1016/j.urology.2020.06.008DOI Listing
September 2020

Oncological and functional outcomes in patients over 70 years of age treated with robotic radical prostatectomy: a propensity-matched analysis.

World J Urol 2021 Apr 14;39(4):1131-1140. Epub 2020 Jun 14.

Department of Urology, University of Rochester Medical Center, New York, USA.

Purpose: The aim of this study was to report on the safety (complications) and efficacy (oncological and functional outcomes) of robot-assisted radical prostatectomy (RARP), performed at our institution, in patients aged over 70.

Patients And Methods: Review of our prospectively collected database [Cancer Information Systems (CAISIS)] identified two hundred and fifteen (215) patients, aged > 70, who underwent RARP for localized prostate cancer between July 2003 and August 2017. A propensity score-matched analysis, with multiple covariates, was performed to stratify the patients into Age ≤ 70 and Age > 70 comparison groups.

Results: Apart from Age (mean ± SD years: 73.5 ± 2.1 vs 59.5 ± 5.9, p < 0.0001) and nerve-sparing status, the two groups were evenly matched for all covariates (p values > 0.05). Median follow-up was 10.6 years. There were no 90-day mortalities in either group. Minor complications (Clavien ≤ 2) were more common in the Age > 70 group (p = 0.0002). Operating room time (p = 0.83), length of hospital stay (p = 0.06) and catheterization duration (p = 0.13) were similar. On final pathology, a higher pT stage (p < 0.0001) and pN1 (p = 0.003) were observed in the Age > 70 group. However, this did not translate adversely into higher rates of positive surgical margin (p = 0.41) or biochemical relapse (p = 0.72). Allowing for the follow-up duration (median 10.6 years), cancer-specific survival was marginally significant (p = 0.05) with an observed lower rate in the Age > 70 group. In terms of functional outcomes, post-operative erectile dysfunction and pad-free continence were significantly better in the younger cohort (p < 0.0001).

Conclusions: Robot-assisted radical prostatectomy should not be denied to those over 70 years solely on the basis of age. Older men need to be counseled about the likelihood of encountering higher-risk features on final pathology and that their functional outcomes may be worse compared to a younger person.
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http://dx.doi.org/10.1007/s00345-020-03304-xDOI Listing
April 2021

Pillars to improve patient outcomes: training and assessment methods for surgery.

World J Urol 2020 Jul;38(7):1591-1593

Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.

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http://dx.doi.org/10.1007/s00345-020-03274-0DOI Listing
July 2020

Transvesical Versus Transabdominal - Which is the Best Approach to Bladder Diverticulectomy Using the Single Port Robotic System?

Urology 2020 Aug 20;142:248. Epub 2020 May 20.

Department of Urology, University of Rochester Medical Center (URMC), Rochester, NY.

Objective: Application of the Single Port (SP) robotic platform [Intuitive] is expanding. Using 2 illustrative examples of bladder diverticula (BD) resulting from bladder outflow obstruction (BOO), we describe in this video our techniques utilizing SP to treat BD via Extravesical (EV#1) and Transvesical (TV#2) approaches.

Methods: In EV#1, a 56-year old, with BOO due to benign prostate enlargement (BPE) of a 30 mL prostate, and a 5 cm BD, was treated with RABD-SP. A subumbilical SP access was used to approach and excise the BD in an EV fashion. The BPE was treated with Rezum. A 16 Fr urethral catheter was placed. In TV#2, a 67-year old, with urinary retention due to a 55 mL BPE and a 6 cm BD in the right posterolateral aspect adjacent the ureteric orifice, was treated with RABD-SP using a Gelport (no additional assistant ports). An open cut-down was performed onto a prefilled bladder and secured onto the abdominal wall with stay sutures. After draining the bladder, a Gelport was introduced into the bladder for SP docking with pneumo-vesical insufflation. Intravesical (inside-out) excision of the BD was performed with protection of the adjacent right ureteric orifice with an open access ureteral catheter. Utilizing the TV access, a simple prostatectomy was performed. A 22 Fr, 3-way catheter was placed at the end.

Results: For EV#1 and TV#2, estimated blood losses were 5 and 100 mL, length stay was 1 day in both, without any immediate perioperative complications. Both patients had successful trials of void on postoperative day 7 and 9, respectively.

Conclusion: RABD-SP can be customized to treat BD, via transabdominal (extravesical) or transvesical (with bladder pneumo-insufflation) approaches, and combined with different BOO treatments (Rezum or simple prostatectomy, for instance), in a patient-specific personalized manner.
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http://dx.doi.org/10.1016/j.urology.2020.05.018DOI Listing
August 2020

Role of 3D printing in surgical education for robotic urology procedures.

Transl Androl Urol 2020 Apr;9(2):931-941

University of Rochester Medical Center (URMC), Rochester, NY, USA.

During the past 5 years, the body of literature surrounding the utilization of three-dimensional (3D) printing in the field of urology has grown exponentially. Incentivized by work hour restrictions, patient safety initiatives, and inspired by technical advances in biomaterials and rapid printing strategies, this emerging, and fascinating area of research has begun to make headway into clinical practice. However, concerns about cost, limited understanding of the technical processes involved, and lack of its potential uses remain barriers to its widespread adoption. We examined existing published literature on how 3D printing technologies have been utilized in the field of Urology to enhance pre-operative planning, revitalize surgical training, and modernize patient education, with particular focus on, robotic surgery. To date, 3D-printed models have been used and studied most commonly in the preoperative planning for nephron-sparing surgeries during the treatment of renal masses, where the challenges of complex renal anatomy and benefits of reducing renal ischemic injury create the most intuitive value. Prostate models are the second most common, particularly in the planning of nerve-sparing procedures. Early studies have demonstrated sufficient realism and educational effectiveness. Subsequent studies demonstrated improved surgeon confidence, operative performance, and optimized patient outcomes including high levels of patient satisfaction. Realistic, accurate, and reasonably priced models can currently be generated within hours using standard desktop 3D printers. While primarily utilized as anatomic replicas of diseased organs that restore a sense of haptic feedback lost in robotic procedures, innovations in polymers, improvements in 3D printer host and modeling software, and upgrades in printer hardware allow this technology to serve as a comprehensive, interactive, simulation platform that can be a critical surgical decision making as well as an effective teaching tool. As Urologists continue to rapidly diversify and iterate upon this adaptive modality, the benefits in patient outcomes will likely outpace the diminishing drawbacks, and we may well see the next revolution in surgical education, robotic techniques, and personalized medicine concurrently.
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http://dx.doi.org/10.21037/tau.2020.01.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214988PMC
April 2020

Correction: Surgical education in the 21st century: implications for sexual medicine.

Int J Impot Res 2020 09;32(5):563

Department of Urology, University of Rochester, Rochester, NY, USA.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41443-020-0268-yDOI Listing
September 2020

Robot-Assisted Simple Prostatectomy: Illustration of a Simplified Extraperitoneal Transcapsular Technique.

Videourology (New Rochelle) 2019 8;33(6). Epub 2019 Apr 8.

Department of Urology, University of Rochester Medical Center (URMC), Rochester, New York.

Robot-assisted simple prostatectomy (RASP) performed with the extraperitoneal (EP) technique (RASP-EP) minimizes the risk of bowel injury, particularly when bowel adhesions may be expected to be prominent, by negating the need to be in the transperitoneal space. However, there is a perception of its technical difficulty owing to the limited space that can be expanded within the space of Retzius. We aimed to describe, in the accompanying video, the step-by-step approach for a technically proficient procedure. From January 2010 to July 2018, 33 consecutive patients who had undergone RASP-EP were identified from our institutional database. Procedures were performed as described stepwise in the accompanying video. In RASP-EP, a 3 cm paraumbilical incision is made, anterior rectus sheath incised, muscle pushed laterally, and the EP space is entered. The EP space is expanded in the retropubic area using a balloon dilator and a blunt ended trocar, enabling the placement of further three ports for robot docking. A transverse capsulotomy, 2 cm from the bladder neck, is performed Millin's. Prostate adenoma is resected circumferentially. Electrocautery hemostasis is performed. Posterior bladder neck and urethra are sutured onto the prostatic fossa with 2-0 Vicryl. A 22F three-way catheter is placed. Anterior capsulotomy is closed in two layers with 2-0 and 0-0 Vicryl sutures. A drain is left in the retropubic space. Patient is discharged within 1-2 days with the catheter , which is then removed 10 days later. Of the 33 patients, median values were age (68), American Society of Anesthesiology (3), Charlson Comorbidity Index (3), and body mass index (28.5 kg/m). Eight (24.2%) patients had prior abdominal surgeries. Twenty-five (75.8%) patients were catheter dependent. Adjunctive procedures were cystolithotomy (5), umbilical hernia repair (2), and ureteroscopy (1). Median values were operative time (178 minutes), estimated blood loss (200 mL), hemoglobin change (2.8 g/dL), and hematocrit change (9%); only one patient (3.0%) required 1 U transfusion. Median length of stay was 2 days. Clavien-Dindo complications were 0 (21), I (7), II (3), IIIa (1), IIIb (1), IV, and V (0). Median resected prostate weight was 122 g. Incidental prostate cancer was found in three patients (9%); one patient required adjuvant radiotherapy. No patients were catheter-dependent postoperatively; mean postvoid residual was 29 mL (range 0-250 mL). Median follow-up was 4 months. RASP-EP is a safe and efficacious technique that should form the repertoire of a urologist's armamentarium when dealing with large adenomas, particularly when entry into the peritoneal cavity is to be avoided. No competing financial interests exist. Runtime of video: 7 mins 5 secs.
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http://dx.doi.org/10.1089/vid.2019.0032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147249PMC
April 2019

Correction to: 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 Jul;38(7):1643

Department of Urology, Simulation Innovation Laboratory, Univeristy of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.

The Eqs. 1, 2 and 3 come under the section "Kidney cortex testing" as per the original manuscript, but they have been incorrectly moved and separated into different sections in the original publication of the article.
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http://dx.doi.org/10.1007/s00345-020-03089-zDOI Listing
July 2020

Surgical education in the 21st century: implications for sexual medicine.

Int J Impot Res 2020 Sep 27;32(5):544-546. Epub 2019 Nov 27.

Department of Urology, University of Rochester, Rochester, New York, USA.

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http://dx.doi.org/10.1038/s41443-019-0218-8DOI Listing
September 2020

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 Jul 2;38(7):1631-1641. Epub 2019 Nov 2.

Department of Urology, Simulation Innovation Laboratory, Univeristy of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.

Introduction And Objectives: There is a scarcity of high-fidelity, life-like, standardized and anatomically correct polymer-based kidney models for robot-assisted partial nephrectomy (RAPN) simulation training. The purpose of this technical report is to present mechanical and functional testing data as evidence for utilizing a perfused hydrogel kidney model created utilizing 3D printed injection casts for RAPN simulation and training.

Methods: Anatomically correct, tumor-laden kidney models were created from 3D-printed casts designed from a patient's CT scan and injected with poly-vinyl alcohol (PVA). A variety of testing methods quantified Young's modulus in addition to comparing the functional effects of bleeding and suturing among fresh porcine kidneys and various formulations of PVA kidneys.

Results: 7% PVA at three freeze-thaw cycles (7%-3FT) was found to be the formula that best replicates the mechanical properties of fresh porcine kidney tissue, where mean(± SD) values of Young's modulus of porcine tissue vs 7%-3FT samples were calculated to be 85.97(± 35) kPa vs 80.97(± 9.05) kPa, 15.7(± 1.6) kPa vs 74.56(± 10) kPa and 87.46(± 2.97) kPa vs 83.4(± 0.7) kPa for unconfined compression, indentation and elastography testing, respectively. No significant difference was seen in mean suture tension during renorrhaphy necessary to achieve observable hemostasis and capsular violation during a simulated perfusion at 120 mmHg.

Conclusions: This is the first study to utilize extensive material testing analyses to determine the mechanical and functional properties of a perfused, inanimate simulation platform for RAPN, fabricated using a combination of image segmentation, 3D printing and PVA casting.
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http://dx.doi.org/10.1007/s00345-019-02989-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730938PMC
July 2020
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