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Biyani CS, Kozan AA, Ferrie L, Richard M, Finch WJG, Rodger F, Elmamoun MH, Hanchanale V, Patterson JM. Creation of a Novel Ex Vivo 3D Printed Ileal Conduit Task Trainer for Teaching Conduitoscopy Skills. Urology 2024:S0090-4295(24)00602-2. [PMID: 39067637 DOI: 10.1016/j.urology.2024.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To perform endoscopy in patients with urinary diversions requires specific endoscopic skills, which can currently only be gained in clinical practice. We created a 3D-printed ex vivo ileal conduit model (stoma and conduit with ureters and 2 kidneys) to simulate "conduitoscopy" and evaluated the realism and limitations of the model. METHODS Accurate anatomical features were represented using an appropriate reusable design, realistic mechanical qualities with several material types, and 3D-printed components. Different models of bowel and ureters were assessed by the subject-matter experts (SME). The final ileal conduit model (Wallace 1 type anastomosis) was evaluated by 18 SMEs. RESULTS Most experts gave their approval to the view of the stoma, as well as the appearance of the bowel, ureteric, and pelvicalyceal systems. A total of 72.1% of SMEs approved the ureteric endoscopic view compared to about 66% who accepted the endoscopic examination of the bowel. The model's overall appearance was good for 61.1% and excellent for 38.8% of experts. CONCLUSION Conduitoscopy simulation training can now be facilitated using our novel and unique cutting-edge 3D-printed model. We created a model that is highly anatomically accurate and workable. In our study, anatomical and visual realism was demonstrated. The next step would be increasing the length of the conduit and conduct a validation study.
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Affiliation(s)
| | - Andrei A Kozan
- Department of Urology, St James's University Hospital, Leeds, West Yorkshire, UK
| | | | | | | | - Flora Rodger
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Vishwanath Hanchanale
- Department of Urology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jake Mark Patterson
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Booth D, Afshari R, Ghovvati M, Shariati K, Sturm R, Annabi N. Advances in 3D bioprinting for urethral tissue reconstruction. Trends Biotechnol 2024; 42:544-559. [PMID: 38057169 DOI: 10.1016/j.tibtech.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
Urethral conditions affect children and adults, increasing the risk of urinary tract infections, voiding and sexual dysfunction, and renal failure. Current tissue replacements differ from healthy urethral tissues in structural and mechanical characteristics, causing high risk of postoperative complications. 3D bioprinting can overcome these limitations through the creation of complex, layered architectures using materials with location-specific biomechanical properties. This review highlights prior research and describes the potential for these emerging technologies to address ongoing challenges in urethral tissue engineering, including biomechanical and structural mismatch, lack of individualized repair solutions, and inadequate wound healing and vascularization. In the future, the integration of 3D bioprinting technology with advanced biomaterials, computational modeling, and 3D imaging could transform personalized urethral surgical procedures.
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Affiliation(s)
- Daniel Booth
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ronak Afshari
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Mahsa Ghovvati
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Kaavian Shariati
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Renea Sturm
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Nasim Annabi
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Tan Q, Le H, Tang C, Zhang M, Yang W, Hong Y, Wang X. Tailor-made natural and synthetic grafts for precise urethral reconstruction. J Nanobiotechnology 2022; 20:392. [PMID: 36045428 PMCID: PMC9429763 DOI: 10.1186/s12951-022-01599-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
Injuries to the urethra can be caused by malformations, trauma, inflammation, or carcinoma, and reconstruction of the injured urethra is still a significant challenge in clinical urology. Implanting grafts for urethroplasty and end-to-end anastomosis are typical clinical interventions for urethral injury. However, complications and high recurrence rates remain unsatisfactory. To address this, urethral tissue engineering provides a promising modality for urethral repair. Additionally, developing tailor-made biomimetic natural and synthetic grafts is of great significance for urethral reconstruction. In this work, tailor-made biomimetic natural and synthetic grafts are divided into scaffold-free and scaffolded grafts according to their structures, and the influence of different graft structures on urethral reconstruction is discussed. In addition, future development and potential clinical application strategies of future urethral reconstruction grafts are predicted.
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Affiliation(s)
- Qinyuan Tan
- Department of Urology, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130061, People's Republic Of China
| | - Hanxiang Le
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, People's Republic Of China
| | - Chao Tang
- Department of Urology, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130061, People's Republic Of China
| | - Ming Zhang
- Department of Urology, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130061, People's Republic Of China
| | - Weijie Yang
- Department of Urology, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130061, People's Republic Of China
| | - Yazhao Hong
- Department of Pediatric Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Street, Nanjing, 210029, People's Republic Of China.
| | - Xiaoqing Wang
- Department of Urology, The First Hospital of Jilin University, 1 Xinmin Street, Changchun, 130061, People's Republic Of China.
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Zhao Y, Liu Y, Dai Y, Yang L, Chen G. Application of 3D Bioprinting in Urology. MICROMACHINES 2022; 13:mi13071073. [PMID: 35888890 PMCID: PMC9321242 DOI: 10.3390/mi13071073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/11/2022]
Abstract
Tissue engineering is an emerging field to create functional tissue components and whole organs. The structural and functional defects caused by congenital malformation, trauma, inflammation or tumor are still the major clinical challenges facing modern urology, and the current treatment has not achieved the expected results. Recently, 3D bioprinting has gained attention for its ability to create highly specialized tissue models using biological materials, bridging the gap between artificially engineered and natural tissue structures. This paper reviews the research progress, application prospects and current challenges of 3D bioprinting in urology tissue engineering.
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Affiliation(s)
- Yue Zhao
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610000, China; (Y.Z.); (Y.D.)
- Department of Public Health Laboratory Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610000, China
| | - Yuebai Liu
- Department of Education and Training, Sichuan Cancer Hospital, Chengdu 610000, China;
| | - Yi Dai
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610000, China; (Y.Z.); (Y.D.)
| | - Luo Yang
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610000, China; (Y.Z.); (Y.D.)
- Correspondence: (L.Y.); (G.C.); Tel.: +86-1-820-288-8984 (G.C.)
| | - Guo Chen
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610000, China; (Y.Z.); (Y.D.)
- Laboratory of Reconstructive Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610000, China
- Correspondence: (L.Y.); (G.C.); Tel.: +86-1-820-288-8984 (G.C.)
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Trelles Guzmán C, Mainez Rodríguez J, Aguado-Maestro I, Cansino Alcaide R, Pérez-Carral J, Martínez-Piñeiro L. Modelo impreso en 3D para entrenamiento en ureteroscopia flexible, una opción de bajo coste para el entrenamiento quirúrgico. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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3D printed model for flexible ureteroscopy training, a low-cost option for surgical training. Actas Urol Esp 2021; 46:16-21. [PMID: 34844902 DOI: 10.1016/j.acuroe.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Training in experimental models is a valid option that improves the outcomes and shortens surgical learning curves. Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. METHODS A 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. Horos™ software was used for segmentation and an FDM-Ultimaker for 3D printing. Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4. The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). RESULTS Printing time was 19 h, with a total cost of €8.77. The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty. The model also allowed the use of baskets and the mobilization and removal of previously placed stones. CONCLUSION We unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.
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A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education. J Robot Surg 2021; 16:749-763. [PMID: 34480323 PMCID: PMC8415702 DOI: 10.1007/s11701-021-01302-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/23/2021] [Indexed: 11/27/2022]
Abstract
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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Nayyar R, Sharma K, Saini S, Das CJ, Singh P, Nayak B, Panaiyadiyan S, Seth A. Clinical Value of Patient-Specific Three-Dimensional Printing of Kidney Before Partial Nephrectomy: A Qualitative Assessment. J Endourol 2021; 35:1405-1410. [PMID: 33779294 DOI: 10.1089/end.2020.1103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To qualitatively assess the clinical usefulness of patient-specific high-fidelity three-dimensional (3D) print model of kidney before partial nephrectomy (PN) and to identify subset domains where it may help in clinical terms. Materials and Methods: Thirteen 3D models were printed for tumors having RENAL nephrometry score of ≥8. Their usage for PN was assessed prospectively using a qualitative questionnaire to be answered on a Likert scale of 1-10. The questions focused on realistic resemblance, preoperative dry surgical run, intertest comparison, surgical impact, and overall beneficence domains as perceived by primary surgeons with respect to surgical conduct during PN. Results: Mean RENAL score was 9.15 (8-11). Models were rated high (9.07 ± 0.86) for realistic resemblance domain and were rated better than contrast-enhanced computed tomography (CECT) (8.38 ± 0.87) and intraoperative ultrasonography (8.07 ± 1.26) for orientation regarding resection margins. A further marginal improvement to 8.2 ± 0.84 was noted against ultrasound where surgeon did a dry cut preoperatively. Use of superselective arterial approach in four, precise awareness about dissection of a major vessel in four, retroperitoneoscopic approach in one, and surgical margin awareness in three were directly attributed to the model. Overall utility of having a model printed was rated high (8.23 ± 1.3). Conclusion: The 3D print models of complex renal tumors have high realistic resemblance to actual patient's anatomy. They were rated better than preoperative CECT or intraoperative ultrasonography for orientation regarding surgical resection margins. It may also help change or modify the surgical plan in a subset of patients with a potential to improve overall outcomes in these complex cases.
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Affiliation(s)
- Rishi Nayyar
- Department of Urology and All India Institute of Medical Sciences, New Delhi, India
| | - Kulbhushan Sharma
- Department of Urology and All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Saini
- Department of Urology and All India Institute of Medical Sciences, New Delhi, India
| | - Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology and All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology and All India Institute of Medical Sciences, New Delhi, India
| | - Sridhar Panaiyadiyan
- Department of Urology and All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology and All India Institute of Medical Sciences, New Delhi, India
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Agung NP, Nadhif MH, Irdam GA, Mochtar CA. The Role of 3D-Printed Phantoms and Devices for Organ-specified Appliances in Urology. Int J Bioprint 2021; 7:333. [PMID: 33997433 PMCID: PMC8114094 DOI: 10.18063/ijb.v7i2.333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/15/2021] [Indexed: 02/08/2023] Open
Abstract
Urology is one of the fields that are always at the frontline of bringing scientific advancements into clinical practice, including 3D printing (3DP). This study aims to discuss and presents the current role of 3D-printed phantoms and devices for organ-specified applications in urology. The discussion started with a literature search regarding the two mentioned topics within PubMed, Embase, Scopus, and EBSCOhost databases. 3D-printed urological organ phantoms are reported for providing residents new insight regarding anatomical characteristics of organs, either normal or diseased, in a tangible manner. Furthermore, 3D-printed organ phantoms also helped urologists to prepare a pre-surgical planning strategy with detailed anatomical models of the diseased organs. In some centers, 3DP technology also contributed to developing specified devices for disease management. To date, urologists have been benefitted by 3D-printed phantoms and devices in the education and disease management of organs of in the genitourinary system, including kidney, bladder, prostate, ureter, urethra, penis, and adrenal. It is safe to say that 3DP technology can bring remarkable changes to daily urological practices.
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Affiliation(s)
- Natanael Parningotan Agung
- Department of Urology, Faculty of Medicine/Ciptomangunkusumo Central Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Hanif Nadhif
- Department of Medical Physics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Medical Technology Cluster, Indonesian Medical Education and Research Institute, Jakarta, Indonesia
| | - Gampo Alam Irdam
- Department of Urology, Faculty of Medicine/Ciptomangunkusumo Central Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Chaidir Arif Mochtar
- Department of Urology, Faculty of Medicine/Ciptomangunkusumo Central Hospital, Universitas Indonesia, Jakarta, Indonesia
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