Page 9 - CUA 2020_Technology and Training_v2

2020 CUA ABSTRACTS

Moderated Poster Session 6: Training, Evaluation

MP-6.1 MP-6.2
A new ureteroscopy training platform that uses computed Analysis of hand/instrument motion during ureteroscopy
tomography urograms to replicate complex patient renal collecting Sylvia Koo , Bader Alsaikhan , Nuley Seo , Kai Fok , Brian Carrillo ,
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system anatomies Monica Farcas 1,3
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Nuley Seo , Bader Alsaikhan , Sylvia Koo , Brian Carillo, Monica Farcas 2 1 University of Toronto, Toronto, ON, Canada; John A. Burns School of
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1 Faculty of Medicine, University of Toronto, Toronto, ON, Medicine, University of Hawaii, Honolulu, HI, United States; Department
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Canada; Department of Urology, St. Michael’s Hospital, Toronto, ON, of Urology, St. Michael’s Hospital, Toronto, ON, Canada
Canada; John A. Burns School of Medicine, University of Hawaii, Introduction: Hand/instrument motion-tracking in surgical simulation can
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Honolulu, HI, United States provide valuable data to improve psychomotor skills, and can serve as a
Introduction: Flexible ureteroscopy (fURS) is a one-person surgical tech- formative evaluative tool. Although motion analysis has been well-studied
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nique, limiting trainees’ ability to practice intraoperatively. Currently, there within laparoscopic surgery, it has been poorly studied in endoscopic sur-
are several simulator models, but few are able to reproduce accurate, com- gery. There are essentially no studies looking at surgeon hand/instrument
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plex collecting systems. We developed an anatomically accurate benchtop motion tracking for flexible ureteroscopy (fURS), a surgical procedure that
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ureteroscopy simulator using 3D reconstructions of patient-specific com- requires a significant amount of hand dexterity. We aimed to develop a
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puted tomography (CT) urograms and elastomer 3D printing technology. ureteroscopic surgery simulation platform that incorporates motion track-
This simulator aims to reproduce realistic challenging anatomies (such as ing capabilities.
sharp infindibulo-pelvic angles and spidery complex collecting systems). Methods: Using the Polhemus system, we designed a motion tracking
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Methods: Patient-specific CT urograms were used to create 3D reconstruc- platform for a benchtop ureteroscopy simulator. This system was designed
tions of the renal collecting system using Slicer . 3D models were then to capture specific instrument/surgeon hand motions determined to be
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modified using Blender . Hollow elastomer kidney models for fURS were important during fURS. Motion data was captured for a specific defined
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created using an Objet 3D TM printer. To test and evaluate the new fURS task performed on the simulator. Using this data, motion analysis metrics
simulator, 25 volunteers were recruited (five novices, 13 residents, seven for fURS were established. Twenty-five volunteers were tested on this new
urologists). The model was compared to an existing fURS model (Cook platform and motion analysis parameters were recorded and analyzed.
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Medical ) on various criteria using the student paired t-test. Furthermore, Results: Using motion tracking software, we analyzed three key motions
volunteers were asked to explore the model with fURS and draw out the during fURS: scope in-out motion, scope rotation, and scope tip flexion.
collecting system from memory. The target task was to visualize an upper, inter, and lower pole calyx on
Results: We were able to use CT urogram and 3D printing technology to cre- a benchtop surgical simulator of the left kidney. Participants paused for
ate a fURS simulator that accurately replicates anatomically complex col- 10 seconds when visualizing each papilla to help discriminate the data.
lecting systems. Using the new model and simulator, we noted that, unlike Twenty-five participants were tested (five novices, 13 residents, seven urolo-
staff urologists, most novices and residents completely missed visualizing gists). While scope in-out motion and scope tip flexion were significantly
the lower pole calyces. A survey comparison between our simulator and different between participants of different expertise, the most discriminatory
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a comparable benchtop simulator (Cook Medical ) revealed consistently metric that differentiated experts from novices was scope rotation (Fig. 1).
better ratings for our simulator on all criteria (p<0.05). Conclusions: We successfully created a fURS simulation platform that cap-
Conclusions: We were able to successfully create an anatomically accu- tures instrument motion. Preliminary data suggests scope rotation is the
rate fURS simulator that can provide a more realistic scoping experience. most discriminatory motion parameter in fURS that differentiates between
Preliminary testing revealed that trainees will benefit from this simulator novice and expert surgeons.
particularly with respect to learning how to navigate challenging collect- References
ing systems. 1. Obstein KL, Patil, VD, Jayender J, et al. Evaluation of colonoscopy
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https://doi.org/10.1186/s12894-015-0067-9
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S109
© 2020 Canadian Urological Association