Tissue Quality Assessment Using a Novel Direct Elasticity Assessment Device (The E-Finger): A Cadaveric Study of Prostatectomy Dissection
Identifieur interne : 003439 ( Ncbi/Curation ); précédent : 003438; suivant : 003440Tissue Quality Assessment Using a Novel Direct Elasticity Assessment Device (The E-Finger): A Cadaveric Study of Prostatectomy Dissection
Auteurs : Daniel W. Good [Royaume-Uni] ; Ashfaq Khan [Royaume-Uni] ; Steven Hammer [Royaume-Uni] ; Paul Scanlan [Royaume-Uni] ; Wenmiao Shu [Royaume-Uni] ; Simon Phipps [Royaume-Uni] ; Simon H. Parson [Royaume-Uni] ; Grant D. Stewart [Royaume-Uni] ; Robert Reuben [Royaume-Uni] ; S. Alan Mcneill [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
English descriptors
- KwdEn :
- MESH :
- instrumentation : Dissection, Prostatectomy, Robotics.
- physiology : Prostate, Urinary Bladder.
- Cadaver, Elasticity, Humans, Male.
Abstract
Minimally invasive radical prostatectomy (RP) (robotic and laparoscopic), have brought improvements in the outcomes of RP due to improved views and increased degrees of freedom of surgical devices. Robotic and laparoscopic surgeries do not incorporate haptic feedback, which may result in complications secondary to inadequate tissue dissection (causing positive surgical margins, rhabdosphincter damage, etc). We developed a micro-engineered device (6 mm2 sized) [E-finger]) capable of quantitative elasticity assessment, with amplitude ratio, mean ratio and phase lag representing this. The aim was to assess the utility of the device in differentiating peri-prostatic tissue types in order to guide prostate dissection.
Two embalmed and 2 fresh frozen cadavers were used in the study. Baseline elasticity values were assessed in bladder, prostate and rhabdosphincter of pre-dissected embalmed cadavers using the micro-engineered device. A measurement grid was created to span from the bladder, across the prostate and onto the rhabdosphincter of fresh frozen cadavers to enable a systematic quantitative elasticity assessment of the entire area by 2 independent assessors. Tissue was sectioned along each row of elasticity measurement points, and stained with haematoxylin and eosin (H&E). Image analysis was performed with Image Pro Premier to determine the histology at each measurement point.
Statistically significant differences in elasticity were identified between bladder, prostate and sphincter in both embalmed and fresh frozen cadavers (p = <0.001). Intra-class correlation (ICC) reliability tests showed good reliability (average ICC = 0.851). Sensitivity and specificity for tissue identification was 77% and 70% respectively to a resolution of 6 mm2.
This cadaveric study has evaluated the ability of our elasticity assessment device to differentiate bladder, prostate and rhabdosphincter to a resolution of 6 mm2. The results provide useful data for which to continue to examine the use of elasticity assessment devices for tissue quality assessment with the aim of giving haptic feedback to surgeons performing complex surgery.
Url:
DOI: 10.1371/journal.pone.0112872
PubMed: 25384014
PubMed Central: 4226612
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PMC:4226612Le document en format XML
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<author><name sortKey="Shu, Wenmiao" sort="Shu, Wenmiao" uniqKey="Shu W" first="Wenmiao" last="Shu">Wenmiao Shu</name>
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<author><name sortKey="Phipps, Simon" sort="Phipps, Simon" uniqKey="Phipps S" first="Simon" last="Phipps">Simon Phipps</name>
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</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
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<orgName type="university">Université d'Édimbourg</orgName>
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<wicri:regionArea>Department of Urology, Western General Hospital, NHS Lothian, Edinburgh</wicri:regionArea>
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<author><name sortKey="Parson, Simon H" sort="Parson, Simon H" uniqKey="Parson S" first="Simon H." last="Parson">Simon H. Parson</name>
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</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Anatomy, University of Edinburgh, Edinburgh</wicri:regionArea>
<placeName><settlement type="city">Édimbourg</settlement>
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</placeName>
<orgName type="university">Université d'Édimbourg</orgName>
</affiliation>
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<author><name sortKey="Stewart, Grant D" sort="Stewart, Grant D" uniqKey="Stewart G" first="Grant D." last="Stewart">Grant D. Stewart</name>
<affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU</wicri:regionArea>
<orgName type="university">Université d'Édimbourg</orgName>
<placeName><settlement type="city">Édimbourg</settlement>
<region type="country">Écosse</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Urology, Western General Hospital, NHS Lothian, Edinburgh</wicri:regionArea>
<placeName><settlement type="city">Édimbourg</settlement>
<region type="country">Écosse</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Reuben, Robert" sort="Reuben, Robert" uniqKey="Reuben R" first="Robert" last="Reuben">Robert Reuben</name>
<affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>School of Engineering and Physical Sciences, Heriot Watt University, Edinburgh</wicri:regionArea>
<placeName><settlement type="city">Édimbourg</settlement>
<region type="country">Écosse</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Mcneill, S Alan" sort="Mcneill, S Alan" uniqKey="Mcneill S" first="S. Alan" last="Mcneill">S. Alan Mcneill</name>
<affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, Edinburgh, EH2 4XU</wicri:regionArea>
<orgName type="university">Université d'Édimbourg</orgName>
<placeName><settlement type="city">Édimbourg</settlement>
<region type="country">Écosse</region>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Urology, Western General Hospital, NHS Lothian, Edinburgh</wicri:regionArea>
<placeName><settlement type="city">Édimbourg</settlement>
<region type="country">Écosse</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS ONE</title>
<idno type="eISSN">1932-6203</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cadaver</term>
<term>Dissection (instrumentation)</term>
<term>Elasticity</term>
<term>Humans</term>
<term>Male</term>
<term>Prostate (physiology)</term>
<term>Prostatectomy (instrumentation)</term>
<term>Robotics (instrumentation)</term>
<term>Urinary Bladder (physiology)</term>
</keywords>
<keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Dissection</term>
<term>Prostatectomy</term>
<term>Robotics</term>
</keywords>
<keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Prostate</term>
<term>Urinary Bladder</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Cadaver</term>
<term>Elasticity</term>
<term>Humans</term>
<term>Male</term>
</keywords>
</textClass>
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</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Introduction</title>
<p>Minimally invasive radical prostatectomy (RP) (robotic and laparoscopic), have brought improvements in the outcomes of RP due to improved views and increased degrees of freedom of surgical devices. Robotic and laparoscopic surgeries do not incorporate haptic feedback, which may result in complications secondary to inadequate tissue dissection (causing positive surgical margins, rhabdosphincter damage, etc). We developed a micro-engineered device (6 mm<sup>2</sup>
sized) [E-finger]) capable of quantitative elasticity assessment, with amplitude ratio, mean ratio and phase lag representing this. The aim was to assess the utility of the device in differentiating peri-prostatic tissue types in order to guide prostate dissection.</p>
</sec>
<sec><title>Material and Methods</title>
<p>Two embalmed and 2 fresh frozen cadavers were used in the study. Baseline elasticity values were assessed in bladder, prostate and rhabdosphincter of pre-dissected embalmed cadavers using the micro-engineered device. A measurement grid was created to span from the bladder, across the prostate and onto the rhabdosphincter of fresh frozen cadavers to enable a systematic quantitative elasticity assessment of the entire area by 2 independent assessors. Tissue was sectioned along each row of elasticity measurement points, and stained with haematoxylin and eosin (H&E). Image analysis was performed with Image Pro Premier to determine the histology at each measurement point.</p>
</sec>
<sec><title>Results</title>
<p>Statistically significant differences in elasticity were identified between bladder, prostate and sphincter in both embalmed and fresh frozen cadavers (p = <0.001). Intra-class correlation (ICC) reliability tests showed good reliability (average ICC = 0.851). Sensitivity and specificity for tissue identification was 77% and 70% respectively to a resolution of 6 mm<sup>2</sup>
.</p>
</sec>
<sec><title>Conclusions</title>
<p>This cadaveric study has evaluated the ability of our elasticity assessment device to differentiate bladder, prostate and rhabdosphincter to a resolution of 6 mm<sup>2</sup>
. The results provide useful data for which to continue to examine the use of elasticity assessment devices for tissue quality assessment with the aim of giving haptic feedback to surgeons performing complex surgery.</p>
</sec>
</div>
</front>
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<biblStruct><analytic><author><name sortKey="Heidenreich, A" uniqKey="Heidenreich A">A Heidenreich</name>
</author>
<author><name sortKey="Bellmunt, J" uniqKey="Bellmunt J">J Bellmunt</name>
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