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首页> 外文期刊>BJU international >Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full‐immersion simulation platform for nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP) utilizing three‐dimensional printing and hydrogel casting technology
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Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full‐immersion simulation platform for nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP) utilizing three‐dimensional printing and hydrogel casting technology

机译：利用三维印刷和水凝胶铸造技术将仿真（CRPMS）临床相关性能指标的临床相关性能指标算入和验证模拟（CRPMS）中的临床相关性能度量

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Objectives To incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP). Materials and Methods Anatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into three‐dimensionally printed injection molds. The following steps of NS‐RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload 500) and nine novices (caseload 50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post‐simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180‐mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. Results The expert group achieved faster task‐specific times for nerve‐sparing ( P = 0.007) and superior surgical margin results ( P = 0.011). Nerve forces applied were significantly lower for the expert group with regard to maximum force ( P = 0.011), average force ( P = 0.011), peak frequency ( P = 0.027) and total energy ( P = 0.003). Higher force sensitivity (subcategory of GEARS score) and total GEARS score correlated with lower nerve forces (total energy in Joules) applied to NVB during the simulation with a correlation coefficient (r value) of ?0.66 ( P = 0.019) and ?0.87 ( P = 0.000), respectively. Both total and force sensitivity GEARS scores were significantly higher in the expert group compared to the novice group ( P = 0.003). UVA leak rate highly correlated with total RACE score r value = ?0.86 ( P = 0.000). Mean RACE scores were also significantly different between novices and experts ( P = 0.003). Conclusion We present a realistic, feedback‐driven, full‐immersion simulation platform for the development and evaluation of surgical skills pertinent to NS‐RARP. The correlation of validated objective metrics (GEARS and RACE) with our CRPMS suggests their application as a novel method for real‐time assessment and feedback during robotic surgery training. Further work is required to assess the ability to predict live surgical outcomes.
机译：将临床相关性能指标（CRPMS）的临床相关性能指标纳入神经备件机器人辅助自由基前列腺切除术（NS-RARP）的水凝胶模型中。通过将聚乙烯醇（PVA）水凝胶注入三维印刷的注射模具，从患者MRI创建了人骨盆，膀胱，前列腺，尿道，神经血管束（NVB），神经血管束（NVB）和相关相邻结构的原型准确模型。模拟NS-RARP的以下步骤：膀胱颈部解剖;精囊动员; NVB解剖;和尿道吻合术（UVA）。五位专家（Caseload＆Gt; 500）和九个新手（桶装＆ 50）完成了模拟。通过制造成NVB的新型张力线传感器系统量化在解剖中施加到NVB的力。仿真后边际状态（通过将化学发光反应与荧光染料诱导分析到前列腺PVA）和UVA风湿性（通过标准的180ml泄漏试验）评估。客观评分，采用全球评估机器人技能（齿轮）和机器人吻合素竞争力评估（种族），由两个盲格外科医生进行。齿轮分数与施加到NVB的力相关，并且种族评分与UVA泄漏率相关。结果专家组达到了更快的任务特定时间，用于神经备件（P = 0.007）和优异的手术边距结果（P = 0.011）。对于最大力（P = 0.011），平均力（P = 0.011），峰值频率（P = 0.027）和总能量（P = 0.003），专家组施加的神经力显着降低。较高的力敏感度（齿轮得分子类别）和总齿轮分数与下神经力（焦耳总能量）相关（焦耳总能量），在模拟期间施加到NVB，其相关系数（R值）的β0.66（P = 0.019）和？0.87（ P = 0.000）分别。与新手组相比，专家组的总和力敏感性齿轮分数明显高（P = 0.003）。 UVA泄漏速率与总比率R值高度相关=？0.86（P = 0.000）。在新手和专家之间的平均种族评分也有显着差异（p = 0.003）。结论我们为与NS-RARP有关的外科技能的开发和评估提供了一个现实，反馈驱动的全浸性模拟平台。验证的客观指标（齿轮和比赛）与我们的CRPM的相关性建议其应用作为机器人外科培训期间的实时评估和反馈的新方法。需要进一步的工作来评估预测实时外科结果的能力。

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