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 .

多个中心应用了3D打印来创建由患者设计的物理模型 由治疗团队进行术前计划的成像。 足以进行手术计划，所有可用的聚合物都没有宽容性耐受性组织 允许解剖，止血和缝合的特性。 Trury沉浸式，现实的仿真平台用于执业外科医生，从而增加了可能性。 从彩排到现场案例的技能转移。 梳理图像分割，3D打印和水凝胶成型技术以制造现实， 可利用患者成像的功能和解剖学精确的患者特异性器官幻象 作为肾癌手术术前手术平台。 通过为外科医生提供高保真，特定于患者的模拟平台，他们可以在其中 在视觉和身体上的互动，他们将能够计划和打破患者的 足够的沉浸，以便执行实际程序会感到熟悉，并且可以与 信心和精度，以三个基本方面的重点证明这一假设 确定水凝胶聚合物规格硫代实质的乳液特性 尸体肾脏组织和肾脏脉管系统包括无限制的压缩 工业和单轴拉伸拉伸强度强度测试。 元素模型（FEA）将能够确定Young的模量（E）和Poisson的比率（ν） 每个肾脏成分，2）确保肾脏的解剖学精度 通过比较患者特异性肾脏水凝胶的解剖学精度与患者的原始幻象 成像。 患者的成像可以与患者的原始计算机设计覆盖 医学成像以主要为每种结构的定量差异误差（实质，肿瘤，动脉 静脉和尿液系统）。 有效的患者特异性肾脏幻像，可准确压抑解剖学，物理，功能 （出血）和每个患者的放射学特性。 将在单个沉浸式模拟平台内复制肾癌手术的所有元素。 最后，我们的第三个目标将是我们患者特异性手术的可行性，现实主义和val虫 通过研究i）专家的主观外科手术现实主义，用于肾癌手术的彩排环境 泌尿科医生和ii）能够产生有效的手术性能指标（失血，缺血时间， 肿瘤的大小和肿瘤边缘）是对同一患者实时手术的实证。