Development and validation of high fidelity, patient specific, kidney phantoms for surgical rehearsals

开发和验证用于手术演练的高保真度、患者特异性肾脏模型

• 批准号: 9894979
• 负责人: Ahmed Ghazi
• 金额: $ 7.7万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-17 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894979
• 关键词: 3-Dimensional; 3D Print; Abdomen; Address; Anatomy; Appearance; Behavior; Belgium; Cadaver; Computer software; Data; Dehydration; Development; Dissection; Effectiveness; Elements; Ensure; Environment; Healthcare; Hemorrhage; Hemostatic function; Hour; Human; Hydrogels; Image; Immersion; Individual; Injections; Ischemia; Kidney; Learning; Mechanics; Medical Imaging; Modeling; Modulus; Molds; Nephrectomy; Operative Surgical Procedures; Organ; Partner in relationship; Pathology; Patient Schedules; Patient imaging; Patients; Performance; Physicians; Polymers; Polyvinyl Alcohol; Postoperative Complications; Procedures; Process; Property; Radiology Specialty; Renal carcinoma; Sampling; Scanning; Schedule; Series; Specimen; Structure; Structure of renal vein; Surgeon; Surgical sutures; Techniques; Technology; Tensile Strength; Testing; Time; Tissues; Training; Transferable Skills; Urinary system; Urologist; Validation; Venous; Venous system; base; biomaterial compatibility; cancer surgery; computer design; cost effective; design; experience; experimental study; human tissue; imaging Segmentation; improved outcome; innovation; mechanical properties; model design; models and simulation; operation; physical model; physical property; rehearsal; renal artery; robot assistance; simulation; skills; tool; tumor; virtual reality; virtual surgery

Multiple centers have applied 3D printing to create physical models designed from patients' imaging to be utilized by the treating team for preoperative planning. While the current practice is adequate for surgical planning, none of the available printed polymers have the ability to reproduce tissue properties permitting dissection, hemostasis and suturing. The emphasis of this proposal is to develop a truly immersive, realistic simulation platform for practicing surgeons, thus increasing the likelihood of skills transfer from the rehearsal to the live case. This project will develop and validate the technique of combining image segmentation, 3D printing and hydrogel molding technologies to fabricate realistic, functional and anatomically accurate patient-specific organ phantoms from patients' imaging to be utilized as a preoperative surgical rehearsal platform for renal cancer surgeries. Our underlying hypothesis is that by providing surgeons with a high-fidelity, patient-specific, simulation platform in which they can visually and physically interact, they will be able to plan and then rehearse a patient's procedure with sufficient immersion so that performing the actual procedure will feel familiar and can be performed with confidence and precision. Proving this hypothesis will focus on three essential aspects including 1) determining hydrogel polymer specifications that would replicate the physical properties of parenchymal cadaveric kidney tissue as well as renal vasculature. Tests include an unconfined compression, indentation and uniaxial tensile strength testing. Dual parameter optimization using an inverse finite element model (FEA) will enable determination of both Young's modulus (E) and Poisson's ratio (ν) for each individual kidney component, 2) ensuring the anatomical accuracy of the fabricated kidney phantoms by comparing the anatomical accuracy of patient-specific kidney hydrogels to patients' original imaging. Scanning and segmentation of the models will generate a duplicate computer design of the patient's imaging that can be overlaid with the patient's original computer design generated from their medical imaging to provide a quantitative difference error for each structure (parenchyma, tumor, arterial, venous and urinary systems). In achieving these first two aims we will have the capability to create cost- effective patient-specific kidney phantoms that accurately represent the anatomical, physical, functional (bleeding) and radiological properties of each patient. Incorporating the essential surrounding organs would replicate all elements of kidney cancer surgery within a single immersive simulation platform. Finally, our third aim will be to assess the feasibility, realism and validity of our patient-specific surgical rehearsal environment for use in kidney cancer surgery by study of i) subjective surgical realism by expert urologists, and ii) ability to generate valid metrics of operative performance (blood loss, ischemia time, tumor size and tumor margins) that positively correlate to live surgery for the same patient .

多个中心已经应用3D打印来创建根据患者设计的物理模型。 治疗团队将使用成像进行术前计划。虽然目前的做法是 对于手术计划来说，没有一种可用的打印聚合物具有复制组织的能力， 允许剥离、止血和剥离的特性。这项建议的重点是发展一个 为执业外科医生提供真正身临其境的逼真模拟平台，从而增加 技能从排练转移到现场案例。该项目将开发和验证以下技术： 结合图像分割、3D打印和水凝胶成型技术， 利用来自患者成像的功能和解剖学上精确的患者特异性器官模型 作为肾癌手术的术前手术排练平台。我们的基本假设是 通过为外科医生提供一个高保真的、针对患者的模拟平台， 视觉和身体互动，他们将能够计划，然后排练病人的程序， 充分的浸泡，以便执行实际程序将感到熟悉，并可以执行 信心和精确度。证明这一假设将集中在三个基本方面，包括1） 确定水凝胶聚合物的规格， 尸体肾组织以及肾脉管系统。测试包括无侧限压缩， 压痕和单轴拉伸强度测试。双参数优化使用逆有限 有限元模型（FEA）将能够确定杨氏模量（E）和泊松比（ν）， 每个单独的肾脏组件，2）确保所制造的肾脏的解剖学准确性 通过比较患者特异性肾脏水凝胶与患者原始肾脏水凝胶的解剖准确性， 显像模型的扫描和分割将产生一个复制的计算机设计， 患者的成像可以与患者的原始计算机设计重叠， 医学成像以提供每个结构（实质，肿瘤，动脉， 静脉和泌尿系统）。在实现前两个目标的过程中，我们将有能力创造成本- 有效的患者特定肾脏体模，准确代表解剖、身体、功能 （出血）和放射学特性。使周围的重要器官 将在一个沉浸式模拟平台上复制肾癌手术的所有要素。 最后，我们的第三个目标将是评估我们的患者特异性手术的可行性，现实性和有效性。 通过研究i）专家的主观手术现实性用于肾癌手术的排练环境 泌尿科医师，和ii）产生手术性能的有效度量（失血，缺血时间， 肿瘤大小和肿瘤边缘），其与同一患者的活体手术正相关。