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Wagner S, Kahl G, Melnyk R, Baumketner A. On the lattice ground state of densely packed hard ellipses. J Chem Phys 2024; 160:151101. [PMID: 38624111 DOI: 10.1063/5.0203311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
Among lattice configurations of densely packed hard ellipses, Monte Carlo simulations are used to identify the so-called parallel and diagonal lattices as the two favorable states. The free energies of these two states are computed for several system sizes employing the Einstein crystal method. An accurate calculation of the free energy difference between the two states reveals the parallel lattice as the state with the lowest free energy. The origin of the entropic difference between the two states is further elucidated by assessing the roles of the translational and rotational degrees of freedom.
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Affiliation(s)
- S Wagner
- Institute for Theoretical Physics, TU Wien, Wiedner Hauptstraße 8-10, A-1040 Wien, Austria
| | - G Kahl
- Institute for Theoretical Physics, TU Wien, Wiedner Hauptstraße 8-10, A-1040 Wien, Austria
| | - R Melnyk
- Institute for Condensed Matter Physics, National Academy of Sciences of Ukraine, 1 Svientsitsky Str., Lviv UA-79011, Ukraine
| | - A Baumketner
- Institute for Condensed Matter Physics, National Academy of Sciences of Ukraine, 1 Svientsitsky Str., Lviv UA-79011, Ukraine
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Saba P, Cook A, Melnyk R, Schuler N, Holler T, Witthaus M, Ralph D, Collins J, Bettocchi C, Van Renterghem K, Ghazi A. Three-dimensional printed hydrogel model vs cadaver: comparing inflatable penile prosthesis training and evaluation. J Sex Med 2023:qdad071. [PMID: 37344000 DOI: 10.1093/jsxmed/qdad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Penile prosthesis implantation offers a durable, safe, and effective treatment option for male erectile dysfunction; however, many urologists feel apprehensive and uncomfortable placing penile prostheses due to limited training, low surgical experience, and intra- and postoperative complication management. AIM To compare a previously validated hydrogel inflatable penile prosthesis (IPP) training model with cadaver simulations across 4 main categories: anatomic replication and realism, procedural replication and realism, educational effectiveness, and efficacy and safety. METHODS An overall 88 participants (15 attendings, 18 fellows, and 55 residents) performed guided IPP placements on a cadaver and a hydrogel model. Based on a 5-point Likert scale, postsurveys were used to assess the participants' opinions regarding anatomic replication and realism, procedural replication and realism, educational effectiveness, and safety between the hydrogel model and cadavers. OUTCOMES A direct head-to-head scenario was created, allowing participants to fully utilize the hydrogel model and cadaver, which ensured the most accurate comparison possible. RESULTS A total of 84% agreed that the hydrogel model replicates the relevant human cadaveric anatomy for the procedure, whereas 69% agreed that the hydrogel tissue resembles the appearance of cadaveric tissue. Regarding the pubic bone, outer skin, corporal bodies, dartos layer, and scrotum, 79%, 74%, 82%, 46%, and 30% respectively agreed that the hydrogel tissue resembled the texture/behavior of cadavers. Furthermore, 66% of participants agreed that the hydrogel model replicates all the procedural steps. Specifically, participants agreed that the model replicates the skin incision/dartos dissection (74%), placement of stay suture and corporotomy (92%), corporal dilation (81%), measurement of prosthetic size (98%), reservoir placement (43%), IPP placement (91%), scrotal pump placement (48%), and skin closure (51%). Finally, 86%, 93%, and 78% agreed that the hydrogel model is useful for improving technical skills, as a teaching/practicing tool, and as an evaluation tool, respectively. To conclude, 81% of participants stated that they would include the hydrogel model platform in their current training. CLINICAL IMPLICATIONS By replicating the IPP procedure, the hydrogel model offers an additional high-fidelity training opportunity for urologists, allowing them to improve their skills and confidence in placing penile prostheses, with the goal of improving patient surgical outcomes. STRENGTHS AND LIMITATIONS The hydrogel training model allows users to perform the entire IPP placement procedure with high anatomic realism and educational effectiveness, maintaining many of the high-fidelity benefits seen in cadavers while improving safety and accessibility. CONCLUSION Ultimately, this high-fidelity nonbiohazardous training model can be used to supplement and bolster current IPP training curriculums.
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Affiliation(s)
- Patrick Saba
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, United States
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Andrew Cook
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, United States
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Rachel Melnyk
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, United States
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Nathan Schuler
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, United States
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Tyler Holler
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, United States
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Michael Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - David Ralph
- St Peters Andrology Centre, King Edward VII Hospital, London, W1G 6AA, United Kingdom
- University College London, London, WC1E 6BT, United Kingdom
- EAU Section of Genitourinary Reconstructive Surgeons, Arnhem, NL-6803 AA, The Netherlands
| | - Justin Collins
- University College London, London, WC1E 6BT, United Kingdom
| | - Carlo Bettocchi
- Cattedra di Urologia-Policlinico, University of Bari, Bari, 70124, Italy
| | - Koenraad Van Renterghem
- Department of Urology, Jessa Ziekenhuis-Campus Salvator, Hasselt, 3500, Belgium
- Faculty of Medicine, Hasselt University, Hasselt, 3500, Belgium
- Department of Urology, University Hospitals Leuven, Zonhoven, 3520, Belgium
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, United States
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, NY 14642, United States
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Melnyk R, Trokhymchuk A, Baumketner A. Excluded volume of the system of hard-core spheres revisited: New insights from computer simulations. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.120672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Baumketner A, Melnyk R. Kagome lattice made by impenetrable ellipses with attractive walls. Soft Matter 2022; 18:3801-3814. [PMID: 35522892 DOI: 10.1039/d2sm00479h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Low-dimensional structures, such as the kagome lattice, are experiencing renewed interest within the physics, chemistry and materials science communities in terms of both basic and applied research. Herein, we show that stable kagome lattices can be made by hard-core ellipses with attractive walls. We study a model in which hard-core ellipse is covered uniformly by an attractive square-well layer. Analytical calculations predict that for certain combinations of the asphericity aspect ratio and the attraction range, the kagome lattice is the ground-state conformation of this model. For one specific set of parameters computer simulations prove that the kagome lattice is the lowest free energy structure at low temperatures. At high temperatures, the conformational ensemble is dominated by liquid states. The temperature at which transition from the liquid to the kagome structure occurs has a maximum as a function of density, indicating that the underlying phase transformation is re-entrant. The maximum is attributed to the energy difference between the liquid and crystalline states. Our study reveals that the kagome lattice can be produced by means of very simple models. No specifically designed molecular shapes or interactions are required. Instead, very basic physical characteristics, such as asphericity and uniform attraction, are sufficient to induce spontaneous transition into this structure. In the context of the general understanding of the self-assembly processes, this finding is encouraging, giving one hope that the requirements for the assembly of other low-dimensional structures could be equally simple.
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Affiliation(s)
- A Baumketner
- Institute for Condensed Matter Physics, National Academy of Sciences of Ukraine, 1 Svientsistsky Str., Lviv, UA-79011, Ukraine.
| | - R Melnyk
- Institute for Condensed Matter Physics, National Academy of Sciences of Ukraine, 1 Svientsistsky Str., Lviv, UA-79011, Ukraine.
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Ghazi A, Melnyk R, Melnyk J, Jain R, Quarrier S, Krambeck A, Miller N, Gopal N, Humphreys M. V02-01 DESIGN AND VALIDATION OF A NON-BIOHAZARDOUS SIMULATION MODEL FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP). J Urol 2022. [DOI: 10.1097/ju.0000000000002528.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Melnyk R, Saba P, Holler T, Cameron K, Mithal P, Rappold P, Wu G, Cubillos J, Rashid H, Joseph JV, Ghazi AE. Design and Implementation of an Emergency Undocking Curriculum for Robotic Surgery. Simul Healthc 2022; 17:78-87. [PMID: 34387245 DOI: 10.1097/sih.0000000000000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Current training for robotic surgery crisis management, specifically emergency robotic undocking protocol (ERUP), remains limited to anecdotal experience. A curriculum to impart the skills and knowledge necessary to recognize and complete a successful ERUP was developed using an education approach then evaluated. METHODS Baseline knowledge and confidence regarding ERUP were established for 5 robotic teams before completing 2 full-immersion simulations separated by an online self-paced learning module. In each simulation, teams operated on a perfused hydrogel model and were tasked to dissect a retroperitoneal tumor abutting a major vessel. During vascular pedicle ligation, a major vascular bleed and nonrecoverable robotic fault were remotely induced, necessitating ERUP with open conversion. After the simulation, participants completed surgery task load index (cognitive load assessment) and realism surveys. Weighted checklists scored participants' actions during each simulation. Surgical metrics including estimated blood loss, time to control bleeding, and undocking time were recorded. Curriculum retention was assessed by repeating the exercise at 6 months. RESULTS Participants experienced high levels of cognitive demand and agreed that the simulation's realism and stress mimicked live surgery. Longitudinal analysis showed significant knowledge (+37.5 points, p = 0.004) and confidence (+15.3 points, p < 0.001) improvements from baseline to completion. Between simulations, checklist errors, undocking time, and estimated blood loss decreased (38⇾17, -40 seconds, and -500 mL, respectively), whereas action scores increased significantly (+27 points, p = 0.008). At 6 months, insignificant changes from curriculum completion were seen in knowledge (-4.8 points, p = 0.36) and confidence (+3.7 points, p = 0.1). CONCLUSIONS This simulation-based curriculum successfully improves operative team's confidence, knowledge, and skills required to manage robotic crisis events.
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Affiliation(s)
- Rachel Melnyk
- From the Simulation Innovation Lab (R.M., P.S., T.H., K.C., A.E.G.) and Department of Urology (P.M., P.R., G.W., J.C., H.R., J.V.J., A.E.G.), University of Rochester Medical Center (URMC), Rochester, NY
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Ghazi A, Melnyk R, Farooq S, Bell A, Holler T, Saba P, Joseph J. Validity of a patient-specific percutaneous nephrolithotomy (PCNL) simulated surgical rehearsal platform: impact on patient and surgical outcomes. World J Urol 2022; 40:627-637. [PMID: 34165633 PMCID: PMC9796494 DOI: 10.1007/s00345-021-03766-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/11/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Simulators provide a safe method for improving surgical skills without the associated patient risks. Advances in rapid prototyping technology have permitted the reconstruction of patient imaging into patient-specific surgical simulations that require advanced expertise, potentially continuing the learning curve. OBJECTIVES To evaluate the impact of preoperative high-fidelity patient-specific percutaneous nephrolithotomy hydrogel simulations on surgical and patient outcomes. MATERIALS AND METHODS Between 2016 and 2017, a fellowship-trained endourologist performed 20 consecutive percutaneous nephrolithotomy procedures at an academic referral center. For the first ten patients, only standard review of patient imaging was completed. For the next ten patients, patient imaging was utilized to fabricate patient-specific models including pelvicalyceal system, kidney, stone, and relevant adjacent structures from hydrogel. The models were tested to confirm anatomic accuracy and material properties similar to live tissue. Full procedural rehearsals were completed 24-48 h before the real case. Surgical metrics and patient outcomes from both groups (rehearsal vs. standard) were compared. RESULTS Significant improvements in mean fluoroscopy time, percutaneous needle access attempts, complications, and additional procedures were significantly lower in the rehearsal group (184.8 vs. 365.7 s, p < 0.001; 1.9 vs. 3.6 attempts, p < 0.001; 1 vs. 5, p < 0.001; and 1 vs. 5, p < 0.001, respectively). There were no differences in stone free rates, mean patient age, body mass index, or stone size between the two groups. CONCLUSION This study demonstrates that patient-specific procedural rehearsal is effective reducing the experience curve for a complex endourological procedure, resulting in improved surgical performance and patient outcomes.
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Affiliation(s)
- Ahmed Ghazi
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA,Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Rachel Melnyk
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Shamroz Farooq
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Adrian Bell
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Tyler Holler
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Patrick Saba
- Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Jean Joseph
- Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Melnyk R, Oppenheimer D, Ghazi AE. How specific are patient-specific simulations? Analyzing the accuracy of 3D-printing and modeling to create patient-specific rehearsals for complex urological procedures. World J Urol 2022; 40:621-626. [PMID: 34390371 PMCID: PMC9808900 DOI: 10.1007/s00345-021-03797-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/30/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE In the field of urology, 3D printing and modeling are now regularly utilized to enhance pre-operative planning, surgical training, patient-specific rehearsals (PSR), and patient education and counseling. Widespread accessibility and affordability of such technologies necessitates development of quality control measures to confirm the anatomical accuracy of these tools. Herein, we present three methods utilized to evaluate the anatomical accuracy of hydrogel PSR, developed using 3D printing and molding for pre-operative surgical rehearsals, of robotic-assisted partial nephrectomy (RAPN) and percutaneous nephrolithotomy (PCNL). METHODS Virtual computer-aided designs (CADs) of patient anatomy were created through segmentation of patient CT scan images. Ten patient-specific RAPN and PCNL hydrogel models were CT scanned and segmented to create a corresponding model CAD. The part compare tool (3-matic, Materialize), point-to-point measurements, and Dice similarity coefficient (DSC) analyzed surface geometry, alignment, and volumetric overlap of each model component. RESULTS Geometries of the RAPN parenchyma, tumor, artery, vein, and pelvicalyceal system lay within an average deviation of 2.5 mm (DSC = 0.70) of the original patient geometry and 5 mm (DSC = 0.45) of the original patient alignment. Similarly, geometries of the PCNL pelvicalyceal system and stone lay within 2.5 mm (DSC = 0.6) and within 15 mm (16% deviation) in alignment. This process enabled the refinement of our modeling process to fabricate anatomically accurate RAPN and PCNL PSR. CONCLUSION As 3D printing and modeling continues to have a greater impact on patient care, confirming anatomical accuracy should be introduced as a quality control measure prior to use for patient care.
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Affiliation(s)
- Rachel Melnyk
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA
| | | | - Ahmed E Ghazi
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA.
- Department of Urology, URMC, Rochester, NY, USA.
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Melnyk R, Chen Y, Holler T, Schuler N, Saba P, Quarrier S, Bloom J, Tabayoyong W, Frye T, Rashid H, Joseph J, Ghazi A. Utilizing head-mounted eye trackers to analyze patterns and decision-making strategies of 3D virtual modelling platform (IRIS ™) during preoperative planning for renal cancer surgeries. World J Urol 2022; 40:651-658. [PMID: 35066636 DOI: 10.1007/s00345-021-03906-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE IRIS™ provides interactive, 3D anatomical visualizations of renal anatomy for pre-operative planning that can be manipulated by altering transparency, rotating, zooming, panning, and overlaying the CT scan. Our objective was to analyze how eye tracking metrics and utilization patterns differ between preoperative surgical planning of renal masses using IRIS and CT scans. METHODS Seven surgeons randomly reviewed IRIS and CT images of 9 patients with renal masses [5 high complexity (RENAL score ≥ 8), 4 low complexity (≤ 7)]. Surgeons answered a series of questions regarding patient anatomy, perceived difficulty (/100), confidence (/100), and surgical plan. Eye tracking metrics (mean pupil diameter, number of fixations, and gaze duration) were collected. RESULTS Surgeons spent significantly less time interpreting data from IRIS than CT scans (- 67.1 s, p < 0.01) and had higher inter-rater agreement of surgical approach after viewing IRIS (α = 0.16-0.34). After viewing IRIS, surgical plans although not statistically significant demonstrated a greater tendency towards a more selective ischemia approaches which positively correlated with improved identification of vascular anatomy. Planned surgical approach changed in 22/59 of the cases. Compared to viewing the CT scan, left and right mean pupil diameter and number/duration of fixations were significantly lower when using IRIS (p < 0.01, p < 0.01, p = 0.42, p < 0.01, respectively), indicating interpreting information from IRIS required less mental effort despite under-utilizing its interactive features. CONCLUSIONS Surgeons extrapolated more detailed information in less time with less mental effort using IRIS than CT scans and proposed surgical approaches with potential to enhanced surgical outcomes.
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Affiliation(s)
- Rachel Melnyk
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA.
| | - Yuxin Chen
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA
| | - Tyler Holler
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA
| | - Nathan Schuler
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA
| | - Patrick Saba
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA
| | | | | | | | - Thomas Frye
- Department of Urology, URMC, Rochester, NY, USA
| | - Hani Rashid
- Department of Urology, URMC, Rochester, NY, USA
| | - Jean Joseph
- Department of Urology, URMC, Rochester, NY, USA
| | - Ahmed Ghazi
- Simulation Innovation Lab, University of Rochester Medical Center (URMC), 601 Elmwood Ave, Rochester, NY, USA.,Department of Urology, URMC, Rochester, NY, USA
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Melnyk R, Kalyuzhnyi Y, Kahl G, Baumketner A. Liquid–gas critical point of a two-dimensional system of hard ellipses with attractive wells. J Chem Phys 2022; 156:034102. [DOI: 10.1063/5.0072522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R. Melnyk
- Institute for Condensed Matter Physics, National Academy of Sciences of Ukraine, 1 Svientsistsky Str., Lviv UA-79011, Ukraine
| | - Y. Kalyuzhnyi
- Institute for Condensed Matter Physics, National Academy of Sciences of Ukraine, 1 Svientsistsky Str., Lviv UA-79011, Ukraine
| | - G. Kahl
- Institute for Theoretical Physics and Center for Computational Materials Science (CMS), TU Wien, Wiedner Hauptstraße 8-10/136, A-1040 Wien, Austria
| | - A. Baumketner
- Institute for Condensed Matter Physics, National Academy of Sciences of Ukraine, 1 Svientsistsky Str., Lviv UA-79011, Ukraine
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Saba P, Melnyk R, Holler T, Oppenheimer D, Schuler N, Tabayoyong W, Bloom J, Bandari J, Frye T, Joseph J, Weinberg E, Hollenberg G, Ghazi A. Comparison of Multi-Parametric MRI of the Prostate to 3D Prostate Computer Aided Designs and 3D-Printed Prostate Models for Pre-Operative Planning of Radical Prostatectomies: A Pilot Study. Urology 2021; 158:150-155. [PMID: 34496263 DOI: 10.1016/j.urology.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the use of 3D computed aided designs and 3D-printed models as pre-operative planning tools for urologists, in addition to radiologist interpreted mp-MRIS, prior to radical prostatectomy procedures. METHODS Ten patients with biopsy-positive lesions detected on mp-MRI were retrospectively selected. Radiologists identified lesion locations using a Prostate Imaging-Reporting and Data System (PI-RADS) map and segmented the prostate, lesion(s), and surrounding anatomy to create 3D-CADs and 3D-printed models for each patient. 6 uro-oncologists randomly reviewed three modalities (mp-MRI, 3D-CAD, and 3D-printed models) for each patient and identified lesion locations which were graded for accuracy against the radiologists' answers. Questionnaires assessed decision confidence, ease-of-interpretation, and usefulness for preoperative planning for each modality. RESULTS Using 3D-CADs and 3D-printed models compared to mp-MRI, urologists were 2.4x and 2.8x more accurate at identifying the lesion(s), 2.7x and 3.2x faster, 1.6x and 1.63x more confident, and reported it was 1.6x and 1.7x easier to interpret. 3D-CADs and 3D-printed models were reported significantly more useful for overall pre-operative planning, identifying lesion location(s), determining degree of nerve sparing, obtaining negative margins, and patient counseling. Sub-analysis showed 3D-printed models demonstrated significant improvements in ease-of-interpretation, speed, usefulness for obtaining negative margins, and patient counseling compared to 3D-CADs. CONCLUSION 3D-CADs and 3D-printed models are useful adjuncts to mp-MRI in providing urologists with more practical, accurate, and efficient pre-operative planning.
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Affiliation(s)
- Patrick Saba
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - Rachel Melnyk
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - Tyler Holler
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - Daniel Oppenheimer
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York
| | - Nathan Schuler
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York
| | - William Tabayoyong
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Jonathan Bloom
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Jathin Bandari
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Thomas Frye
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Jean Joseph
- University of Rochester Medical Center, Department of Urology, Rochester, New York
| | - Eric Weinberg
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York
| | - Gary Hollenberg
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, New York
| | - Ahmed Ghazi
- University of Rochester Medical Center, Department of Urology, Simulation Innovation Laboratory, Rochester, New York.
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McGann KC, Melnyk R, Saba P, Joseph J, Glocker RJ, Ghazi A. Implementation of an E-Learning Academic Elective for Hands-On Basic Surgical Skills to Supplement Medical School Surgical Education. J Surg Educ 2021; 78:1164-1174. [PMID: 33309226 DOI: 10.1016/j.jsurg.2020.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/25/2020] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To examine the feasibility and utility of a completely online surgical skills elective for undergraduate medical students. DESIGN The fully asynchronous, one-week, online learning elective addressed surgical instrument identification, knot tying, and suturing. Tools for knowledge acquisition and self-practice were outlined and individualized performance feedback on technical skills performance was incorporated from peers and experts through video conference. SETTING University of Rochester School of Medicine & Dentistry, Rochester, NY. PARTICIPANTS A total of 86 third- and fourth-year medical students enrolled and successfully completed the elective. RESULTS At elective completion, nearly all students met their course objectives and significantly increased their confidence in surgical instrument identification, knot tying, and suturing. Objective measures of student knowledge and technical skills acquisition were overwhelmingly positive, and faculty and students were very satisfied with providing and receiving performance feedback. Students reported that expert feedback was more useful than peer feedback, and more students than faculty reported that the online modality was equivalent to an in-person session for performance review. CONCLUSIONS This innovative online surgical skills elective improved undergraduate medical student confidence, knowledge, and skillset with surgical instrument identification, knot tying, and suturing while also facilitating effective expert feedback on individual performance.
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Affiliation(s)
- Kevin C McGann
- University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Rachel Melnyk
- Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, Rochester, New York
| | - Patrick Saba
- Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, Rochester, New York
| | - Julian Joseph
- Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, Rochester, New York
| | - Roan J Glocker
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ahmed Ghazi
- Department of Urology, Simulation Innovation Lab, University of Rochester Medical Center, Rochester, New York.
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Saba P, Ayers B, Melnyk R, Gosev I, Ghazi A, Hicks G. Development of a high-fidelity coronary artery bypass graft training platform using 3-dimensional printing and hydrogel molding. J Thorac Cardiovasc Surg 2021; 161:e291-e293. [DOI: 10.1016/j.jtcvs.2020.05.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
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Kavoussi NL, Pitt B, Ferguson JM, Granna J, Remirez A, Nimmagadda N, Melnyk R, Ghazi A, Barth EJ, Webster RJ, Herrell SD. Accuracy of Touch-Based Registration During Robotic Image-Guided Partial Nephrectomy Before and After Tumor Resection in Validated Phantoms. J Endourol 2021; 35:362-368. [PMID: 33040602 PMCID: PMC7987368 DOI: 10.1089/end.2020.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: Image-guided surgery (IGS) allows for accurate, real-time localization of subsurface critical structures during surgery. No prior IGS systems have described a feasible method of intraoperative reregistration after manipulation of the kidney during robotic partial nephrectomy (PN). We present a method for seamless reregistration during IGS and evaluate accuracy before and after tumor resection in two validated kidney phantoms. Materials and Methods: We performed robotic PN on two validated kidney phantoms-one with an endophytic tumor and one with an exophytic tumor-with our IGS system utilizing the da Vinci Xi robot. Intraoperatively, the kidney phantoms' surfaces were digitized with the da Vinci robotic manipulator via a touch-based method and registered to a three-dimensional segmented model created from cross-sectional CT imaging of the phantoms. Fiducial points were marked with a surgical marking pen and identified after the initial registration using the robotic manipulator. Segmented images were displayed via picture-in-picture in the surgeon console as tumor resection was performed. After resection, reregistration was performed by reidentifying the fiducial points. The accuracy of the initial registration and reregistration was compared. Results: The root mean square (RMS) averages of target registration error (TRE) were 2.53 and 4.88 mm for the endophytic and exophytic phantoms, respectively. IGS enabled resection along preplanned contours. Specifically, the RMS averages of the normal TRE over the entire resection surface were 0.75 and 2.15 mm for the endophytic and exophytic phantoms, respectively. Both tumors were resected with grossly negative margins. Point-based reregistration enabled instantaneous reregistration with minimal impact on RMS TRE compared with the initial registration (from 1.34 to 1.70 mm preresection and from 1.60 to 2.10 mm postresection). Conclusions: We present a novel and accurate registration and reregistration framework for use during IGS for PN with the da Vinci Xi surgical system. The technology is easily integrated into the surgical workflow and does not require additional hardware.
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Affiliation(s)
- Nicholas L. Kavoussi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bryn Pitt
- Department of Mechanical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - James M. Ferguson
- Department of Mechanical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Josephine Granna
- Department of Mechanical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Andria Remirez
- Department of Mechanical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Naren Nimmagadda
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, New York, USA
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J. Barth
- Department of Mechanical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Robert J. Webster
- Department of Mechanical Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Stanley Duke Herrell
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Gurung PMS, Melnyk R, Holler T, Oppenhimer D, Witthaus M, Rashid HH, Frye TP, Wu G, Joseph JV, Ghazi AE. Application of IRIS Three-Dimensional Anatomical Models As Preoperative Surgical Planning Tools in the Management of Localized Renal Masses. J Endourol 2021; 35:383-389. [PMID: 33451273 DOI: 10.1089/end.2020.0405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: The use of volume-rendered images is gaining popularity in the surgical planning for complex procedures. IRIS™ is an interactive software that delivers three-dimensional (3D) virtual anatomical models. We aimed to evaluate the preoperative clinical utility of IRIS for patients with ≤T2 localized renal tumors who underwent either partial nephrectomy (PN) or radical nephrectomy (RN). Patients and Methods: Six urologists (four faculty and two trainees) reviewed CT scans of 40 cases over 2 study phases, using conventional two-dimensional (2D) CT alone (Phase-I), followed by the CT + IRIS 3D model (Phase-II). After each review, surgeons reported their decision on performing a PN or an RN and rated (Likert scale) their confidence in completing the procedure as well as how the imaging modality influenced specific procedural decisions. Modifications to the choice of procedure and confidence in decisions between both phases were compared for the same surgeon. Concordance between surgeons was also evaluated. Results: A total of 462 reviews were included in the analysis (231 in each phase). In 64% (95% CI: 58-70%) of reviews, surgeons reported that IRIS achieved a better spatial orientation, understanding of the anatomy, and offered additional information compared with 2D CT alone. IRIS impacted the planned procedure in 20% of the reviews (3.5% changed decision from PN to RN and 16.5% changed from RN to PN). In the remaining 80% of reviews, surgeons' confidence increased from 78% (95% CI: 72-84%) with 2D CT, to 87% (95% CI: 82-92%) with IRIS (p = 0.02); this confidence change was more pronounced in cases with a high RENAL score (p = 0.009). In 99% of the reviews, surgeons rated that the IRIS accurately represented the anatomical details of all kidney components. Conclusion: Application of IRIS 3D models could influence the surgical decision-making process and improve surgeons' confidence, especially for robot-assisted management of complex renal tumors.
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Affiliation(s)
- Pratik M S Gurung
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
| | - Tyler Holler
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
| | - Daniel Oppenhimer
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Hani H Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed E Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
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Melnyk R, Campbell T, Holler T, Cameron K, Saba P, Witthaus MW, Joseph J, Ghazi A. See Like an Expert: Gaze-Augmented Training Enhances Skill Acquisition in a Virtual Reality Robotic Suturing Task. J Endourol 2021; 35:376-382. [PMID: 32967467 DOI: 10.1089/end.2020.0445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: The da Vinci Skills Simulator (DVSS) is an effective platform for robotic skills training. Novel training methods using expert gaze patterns to guide trainees have demonstrated superiority to traditional instruction. Portable head-mounted eye-trackers (HMET) offer the opportunity for eye tracking technology to enhance surgical robotic simulation training. Objective: To evaluate if training guided by expert gaze patterns can improve trainee performance over standard movement training techniques during robotic simulation. Methods: Medical students were recruited and randomized into gaze training (GT, n = 9) and movement training (MT, n = 8) groups. First, the participants reviewed an instructional video, with the GT group emulating expert gaze patterns and the MT group (n = 8) standard movement-based instruction. Training consisted of 10 repetitions of "Suture Sponge 3" on the DVSS while wearing HMET; the first three repetitions were followed by group-appropriate video coaching (gaze vs movement feedback), while the remaining repetitions were without feedback. Finally, two multitasking repetitions with a secondary bell-counting task were completed. Primary outcomes included DVSS scores during training and multitasking. Secondary outcomes included metrics collected from the HMET (gaze patterns and gaze entropy). Results: Total score, efficiency, and penalties improved significantly over the training in both groups; the GT group achieved higher scores on every attempt. Total scores in the GT group were higher than the MT group postvideo review (20.3 ± 21.8 vs 3.0 ± 6.2, p = 0.047), after coaching repetitions (61.8 ± 18.8 vs 30.1 ± 26.2, p = 0.01), and at the last training attempt (73.0 ± 16.5 vs 63.1 ± 17.4, p = 0.247). During multitasking, the GT group maintained higher total scores (75 ± 10.1 vs 63.3 ± 15.3, p = 0.01), efficiency (86.3 ± 7.4 vs 77.4 ± 11.2, p = 0.009), and superior secondary task performance (error: 6.3% ± 0.06 vs 10.7% ± 0.11, p = 0.20). Gaze entropy (cognitive-load indicator) and gaze pattern analysis showed similar trends. Conclusion: Gaze-augmented training leads to more efficient movements through adoption of expert gaze patterns that withstand additional stressors.
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Affiliation(s)
- Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Timothy Campbell
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Tyler Holler
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Katherine Cameron
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael W Witthaus
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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Ghazi A, Saba P, Melnyk R, Joseph J. Utilizing 3D Printing and Hydrogel Casting for the Development of Patient-Specific Rehearsal Platforms for Robotic Assisted Partial Nephrectomies. Urology 2020; 147:317. [PMID: 33129872 DOI: 10.1016/j.urology.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing technology has been utilized to create patient-specific (PS) replicas as visual aids for surgical planning.1-4 However, they cannot recreate the operative experience due to a lack of realistic tissue characteristics. OBJECTIVES Develop anatomically accurate, realistic, PS partial nephrectomy platforms suitable for pre-operative surgical rehearsals using 3D-printing and hydrogel casting. MATERIAL Patient CT scans were segmented into a computer-aided design (CAD) file and used to create injection casts. Kidney and tumor casts along with hollow vascular and urinary structures were 3D-printed. The hilar structures and tumor were registered into the kidney cast, injected with poly-vinyl alcohol (PVA) hydrogel, and processed to create the kidney phantom. Mechanical and functional testing protocols were completed to confirm that the properties of PVA matched the live tissue.5 Anatomical accuracy was confirmed by CT scanning the phantom and creating another CAD, which was compared to the original patient CAD. Full-procedural PS rehearsals were completed 24-48 hours prior to their respective live surgeries. Clinically relevant metrics (warm ischemia time, estimated blood loss, and positive surgical margins) from each rehearsal and live case were compared using a Wilcoxon-rank sum test. RESULTS The 7%-3freeze/thaw PVA best recreated the mechanical and functional properties of porcine kidneys, while anatomical verification showed ≤1 mm deviation of the kidney and tumor from the patient anatomy and ≤3 mm for the hilar structures. PS rehearsal platforms were fabricated using these methods for 8 patients (average tumor size 5.92 cm and nephrometry score 9.8). A positive correlation was found for warm ischemia time and estimated blood loss between rehearsals and live surgeries. CONCLUSION This reproducible method shows high anatomical accuracy, realistic tissue properties, and translational effects between rehearsals and live surgery. To determine the effects on patient outcomes, future studies will compare the impact of completing a pre-operative rehearsal vs standard surgical preparation.
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Affiliation(s)
- Ahmed Ghazi
- University of Rochester Medical Center, Division Department of Urology, 601 Elmwood Ave, Rochester, NY.
| | - Patrick Saba
- University of Rochester Medical Center, Division Department of Urology, 601 Elmwood Ave, Rochester, NY
| | - Rachel Melnyk
- University of Rochester Medical Center, Division Department of Urology, 601 Elmwood Ave, Rochester, NY
| | - Jean Joseph
- University of Rochester Medical Center, Division Department of Urology, 601 Elmwood Ave, Rochester, NY
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18
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Ghazi A, Melnyk R, Hung AJ, Collins J, Ertefaie A, Saba P, Gurung P, Frye T, Rashid H, Wu G, Mottrie A, Costello T, Dasgupta P, Joseph J. Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS). BJU Int 2020; 127:645-653. [PMID: 32936977 DOI: 10.1111/bju.15246] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To conduct a multi-institutional validation of a high-fidelity, perfused, inanimate, simulation platform for robot-assisted partial nephrectomy (RAPN) using incorporated clinically relevant objective metrics of simulation (CROMS), applying modern validity standards. MATERIALS AND METHODS Using a combination of three-dimensional (3D) printing and hydrogel casting, a RAPN model was developed from the computed tomography scan of a patient with a 4.2-cm, upper-pole renal tumour (RENAL nephrometry score 7×). 3D-printed casts designed from the patient's imaging were used to fabricate and register hydrogel (polyvinyl alcohol) components of the kidney, including the vascular and pelvicalyceal systems. After mechanical and anatomical verification of the kidney phantom, it was surrounded by other relevant hydrogel organs and placed in a laparoscopic trainer. Twenty-seven novice and 16 expert urologists, categorized according to caseload, from five academic institutions completed the simulation. RESULTS Clinically relevant objective metrics of simulators, operative complications, and objective performance ratings (Global Evaluative Assessment of Robotic Skills [GEARS]) were compared between groups using Wilcoxon rank-sum (continuous variables) and parametric chi-squared (categorical variables) tests. Pearson and point-biserial correlation coefficients were used to correlate GEARS scores to each CROMS variable. Post-simulation questionnaires were used to obtain subjective supplementation of realism ratings and training effectiveness. RESULTS Expert ratings demonstrated the model's superiority to other procedural simulations in replicating procedural steps, bleeding, tissue texture and appearance. A significant difference between groups was demonstrated in CROMS [console time (P < 0.001), warm ischaemia time (P < 0.001), estimated blood loss (P < 0.001)] and GEARS (P < 0.001). Six major intra-operative complications occurred only in novice simulations. GEARS scores highly correlated with the CROMS. CONCLUSIONS This perfused, procedural model offers an unprecedented realistic simulation platform, which incorporates objective, clinically relevant and procedure-specific performance metrics.
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Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester, Rochester, NY, USA.,Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Andrew J Hung
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Justin Collins
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ashkan Ertefaie
- Department of Biostatistics, University of Rochester, NY, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Pratik Gurung
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Thomas Frye
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Hani Rashid
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Guan Wu
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Alex Mottrie
- Urological Department, OLV Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Tony Costello
- Department Departments of Surgery and Urology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Medical Robotics Academy (AMRA), Melbourne, Vic., Australia
| | - Prokar Dasgupta
- Chair of Urology, Life Sciences and Medicine, King's College London, London, UK
| | - Jean Joseph
- Department of Urology, University of Rochester, Rochester, NY, USA
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19
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Saba P, Belfast E, Melnyk R, Patel A, Kashyap R, Ghazi A. Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies. J Endourol 2020; 34:1088-1094. [DOI: 10.1089/end.2020.0441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Belfast
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Ankit Patel
- Department of Surgery, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Randeep Kashyap
- Department of Surgery, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
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20
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Witthaus MW, Saba P, Melnyk R, Ajay D, Ralph D, Van Renterghem K, Warren G, Munarriz R, Ghazi A. The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory. J Sex Med 2020; 17:2299-2306. [PMID: 32948488 DOI: 10.1016/j.jsxm.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/26/2020] [Accepted: 08/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a significant need for a non-biohazardous, educational platform to equip and maintain the surgical skills required by urology trainees and low-volume implanters for inflatable penile prosthetic (IPP) placement. AIM To design and develop an anatomic, hydrogel-based simulation platform for training and evaluate IPP placement using modern education theory. METHODS The backward design concept was used as a framework in the design and development of an IPP simulation platform. Steps included delineating requirements from a physicians' perspective, translating requirements into engineering tasks (deliverables), developing a prototype, and pilot validation. Using a combination of 3-dimensional printing and hydrogel casting, a genitourinary tract model was constructed to replicate the appropriate steps of IPP placement guided by expert feedback. Full-immersion IPP simulations were performed through both infrapubic and penoscrotal approaches by 4 expert surgeons under operative conditions. Questionnaires evaluating the simulation's realism, value as a training tool, and further recommendations were completed. OUTCOMES Using backward design educational pedagogy, a high-fidelity, full-procedural IPP simulation was fabricated and verified as an adequate educational tool for training and assessment. RESULTS An expert consensus on the anatomic landmarks, steps and substeps, instruments, and errors to be included in the model was reached using a hierarchical task analysis and was successfully translated into a prototype hydrogel model. Experts performed all appropriate steps of IPP surgery and rated the simulation highly in terms of its realism and value as a training tool. On average, experts agreed that the model could function as a training tool, assessment tool, prerequisite for IPP accreditation, and requirement before live surgery. Experts stated they would have their trainees ideally complete an average of 1.75 models before live surgical training. All experts believed an operative checklist would be an ideal assessment tool. Witthaus MW, Saba P, Melnyk R, et al. The Future of Penile Prosthetic Surgical Training Is Here: Design of a Hydrogel Model for Inflatable Penile Prosthetic Placement Using Modern Education Theory. J Sex Med 2020;17:2299-2306.
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Affiliation(s)
- Michael W Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA
| | - Divya Ajay
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - David Ralph
- Department of Urology, University College London Hospitals, London, UK
| | | | - Gareth Warren
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA; Simulation Innovation Laboratory, Department of Urology, University of Rochester, Rochester, NY, USA.
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21
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Witthaus MW, Farooq S, Melnyk R, Campbell T, Saba P, Mathews E, Ezzat B, Ertefaie A, Frye TP, Wu G, Rashid H, Joseph JV, Ghazi A. 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. BJU Int 2019; 125:322-332. [PMID: 31677325 DOI: 10.1111/bju.14940] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Michael W Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shamroz Farooq
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy Campbell
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Patrick Saba
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Eric Mathews
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Bahie Ezzat
- Hajim School of Engineering, University of Rochester, Rochester, NY, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Hani Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
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22
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Weiss MY, Melnyk R, Mix D, Ghazi A, Vates GE, Stone JJ. Design and Validation of a Cervical Laminectomy Simulator using 3D Printing and Hydrogel Phantoms. Oper Neurosurg (Hagerstown) 2019; 18:202-208. [DOI: 10.1093/ons/opz129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Menachem Y Weiss
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Rachel Melnyk
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Doran Mix
- Department of Vascular Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - G Edward Vates
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
| | - Jonathan J Stone
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
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Ghazi A, Campbell T, Melnyk R, Feng C, Andrusco A, Stone J, Erturk E. Validation of a Full-Immersion Simulation Platform for Percutaneous Nephrolithotomy Using Three-Dimensional Printing Technology. J Endourol 2017; 31:1314-1320. [DOI: 10.1089/end.2017.0366] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Timothy Campbell
- School of Medicine and Dentistry University of Rochester Medical Center, Rochester, New York
| | - Rachel Melnyk
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Changyong Feng
- Department of Biostatistics & Computational Biology, University of Rochester, Rochester, New York
| | - Alex Andrusco
- Urology Department, Hospital Sotero del Rio and Hospital DIPRECA, Santiago, Chile
| | - Jonathan Stone
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York
| | - Erdal Erturk
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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Baumketner A, Melnyk R, Holovko MF, Cai W, Costa D, Caccamo C. Softness and non-spherical shape define the phase behavior and the structural properties of lysozyme in aqueous solutions. J Chem Phys 2016; 144:015103. [PMID: 26747821 DOI: 10.1063/1.4939637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In this study, Boltzmann inversion is applied in conjunction with molecular dynamics simulations to derive inter-molecular potential for protein lysozyme in aqueous solution directly from experimental static structure factor. The potential has a soft repulsion at short distances and an attraction well at intermediate distances that give rise to the liquid-liquid phase separation. Moreover, Gibbs ensemble Monte Carlo simulations demonstrate that a non-spherical description of lysozyme is better suited to correctly reproduce the experimentally observed properties of such a phase separation. Our findings shed new light on the common problem in molecular and cell biology: "How to model proteins in their natural aqueous environments?"
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Affiliation(s)
- A Baumketner
- Institute for Condensed Matter Physics, NAS of Ukraine, 1 Svientsistsky St., Lviv 79011, Ukraine
| | - R Melnyk
- Institute for Condensed Matter Physics, NAS of Ukraine, 1 Svientsistsky St., Lviv 79011, Ukraine
| | - M F Holovko
- Institute for Condensed Matter Physics, NAS of Ukraine, 1 Svientsistsky St., Lviv 79011, Ukraine
| | - W Cai
- Institute of Natural Sciences, Shanghai Jiao Tong University, Shanghai 200240, China
| | - D Costa
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina and Consorzio Nazionale Interuniversitario per la Fisica della Materia, Viale F. Stagno d'Alcontres 31, 98166 Messina, Italy
| | - C Caccamo
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina and Consorzio Nazionale Interuniversitario per la Fisica della Materia, Viale F. Stagno d'Alcontres 31, 98166 Messina, Italy
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Lebovka NI, Khrapatiy S, Melnyk R, Vygornitskii M. Effects of hydrodynamic retardation and interparticle interactions on the self-assembly in a drying droplet containing suspended solid particles. Phys Rev E 2014; 89:052307. [PMID: 25353800 DOI: 10.1103/physreve.89.052307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Indexed: 11/07/2022]
Abstract
Self-assembly of particles, suspended in a drying droplet, were studied by the Monte Carlo method. The Brownian diffusion of particles was simulated accounting for the effect of hydrodynamic retardation and interparticle interactions. The model allowed for explaining formation of the "coffee ring" patterns even without accounting for the radial flows towards the three-phase contact line. Morphologies of the drying patterns and their dependence on interparticle interactions and concentration of particles are discussed.
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Affiliation(s)
- N I Lebovka
- Institute of Biocolloidal Chemistry named after F. D. Ovcharenko, NAS of Ukraine, 42, blvr. Vernadskogo, Kyiv 03142, Ukraine
| | - S Khrapatiy
- Taras Shevchenko National University of Kyiv, Institute of Biology, 2, prospekt Hlushkov, Kyiv, 03022, Ukraine
| | - R Melnyk
- National University of Kyiv-Mohyla Academy, Faculty of Natural Sciences, Department of Physics and Mathematics, 2 Skovorody vul., Kyiv 04655, Ukraine
| | - M Vygornitskii
- Institute of Biocolloidal Chemistry named after F. D. Ovcharenko, NAS of Ukraine, 42, blvr. Vernadskogo, Kyiv 03142, Ukraine
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Melnyk R, Montgomery R, Over R. Attitude changes following a sexual counseling program for spinal cord injured persons. Arch Phys Med Rehabil 1979; 60:601-5. [PMID: 518269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The attitudes of a sample of spinal cord injured outpatients toward a range of sexual behaviors were measured before and after participation in a counseling program. In comparison to the sexual attitudes of an untreated control group those of the sample group were found to be more permissive after than before the program. In addition, the counseling program, which operated in a workshop format over a period of 6 weeks, was favorably evaluated by participants on a number of criteria.
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