Poster, Podium & Video Sessions
Presentation Authors: Jonathan Stone, Rachel Melnyk, Guan Wu, Hani Rashid, Jean Joseph, Ahmed Ghazi*, Rochester, NY
Introduction: The benefits of surgical simulation have been previously demonstrated to enhance technical skills with a downstream effect of improved patient outcomes. However, other methods to utilize simulation technology remain under-explored. One area of simulation that has proven to be difficult is the creation of a high fidelity process that accurately and reproducibly simulates individual anatomy and pathology (i.e. patient specific simulators). Advances in 3-D printing and polymer technology, coupled with software that incorporates imaging data into a computer design, make it possible to develop individualized models from patient imaging data. We present the feasibility of patient-specific preoperative rehearsal using 3D processing & printing in complex partial nephrectomy cases.
Methods: Three patients with enhancing renal lesions suspicious for renal malignancy with complex tumor morphology or significant comorbidities were chosen for preoperative simulation and rehearsal. DICOM files of patients C.T. angiography (CTA) were imported into 3D processing software to create virtual models of kidney parenchyma incorporating the tumor, renal vasculature, and pelvicalyceal system. Surgical phantoms were created using 3D printing and polymer hydrogels, for patient-specific surgical rehearsal. For whole task preoperative surgical rehearsal, other relevant anatomical elements (bowel, perinephric fat, solid organs and bony structures) were incorporated into a replicated hemiabdomen.
Results: All 3 preoperative simulations were completed prior to the live case. Partial nephrectomy was successful in all 3 cases with an average blood loss of 300cc and WIT of 20 minutes. For the first case, preoperative 3D processing and hydrogel kidney aided in assessing the depth of resection of a completely endophytic tumor and predicted violation of the pelvicalyceal system in the live case. In the 2nd case, the preoperative rehearsals ascertained the feasibility of completing partial nephrectomy in a 9 cm upper pole mass. In the final case, the preoperative rehearsals confirmed the feeding vessel and viability of selective ischemia with his existing coagulopathy and nephropathy.
Conclusions: This initial trial demonstrates that patient-specific procedural rehearsal is effective for enhancing the performance of surgeons during a complex minimal invasive procedure. This transition from generalized to patient-specific simulation may have the potential to impact patient outcomes by permitting preoperative rehearsal.
Source Of Funding: none
University of Rochester
Dr Ghazi received his MD degree from Cairo University in Egypt in 2000, where he also completed his surgery training and Urology residency 2001-2005. After serving as Faculty for 2 years at the University Hospitals, he started a series of worldwide fellowships in state of the art minimal invasive Urological surgery. He completed a laparoscopic fellowship in Paris, France in 2008 under the supervision of Professor Claude Abbou MD (one of the modern founders and prominent laparoscopic surgeons, who revolutionized the laparoscopic technique for extraperitoneal laparoscopic radical prostatectomy for treatment of prostate cancer).
He then completed a second laparoscopic fellowship in Austria in 2009 under the supervision of Professor Gunter Janetschek MD who specialized in the laparoscopic approach for selective removal of kidney tumors, leaving the remaining kidney intact and functioning. He also introduced the laparoscopic approach for retroperitoneal lymph node dissection in the treatment of testicular cancer evading a large midline incision. During his stay in Europe he received the European Board of Urology. He completed his training at the University of Rochester, New York with a 2 year fellowship in the robotic treatment of various urologic cancers. He joined the staff at the Urology department, University of Rochester in 2012. Dr. Ghazi specializes in the diagnosis and minimal invasive treatment of cancers of the prostate, bladder, kidney, testicle, and other genitourinary organs as well as minimal invasive treatment of various stones of the urinary tract.
Training under the supervision of various pioneers in the field of minimally invasive urology has widened my scope of practice, especially in dealing with difficult cases. I peruse clinical research and stay up to date with innovative techniques that are proven to improve patient outcomes.
Saturday, May 13
7:00 AM – 7:00 AM
Sunday, May 14
10:00 AM – 12:00 PM
Tuesday, May 16
11:10 AM – 11:20 AM