Kinematic and experimental investigation of manual resection tools for transurethral bladder tumor resection.

Nima Sarli, Tracy Marien, Christopher R Mitchell, Giuseppe Del Giudice, Mary S Dietrich, S Duke Herrell, Nabil Simaan

Journal: The international journal of medical robotics + computer assisted surgery : MRCAS 2018;13(2):101002/rcs1757

PMID: 27766732

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Abstract

BACKGROUND

Transurethral Resection of Bladder Tumors (TURBT) is a challenging procedure partly due to resectoscope limitations. To date, manual resection performance has not been fully characterized. This work characterizes manual resection performance in the bladder while analyzing the effect of resection location on accuracy.

METHODS

Kinematic simulations are used to assess kinematic measures of resection dexterity. An experimental protocol for manual resection accuracy assessment is developed. Cross correlations between the theoretical performance measures and the observed experimental accuracy are investigated.

RESULTS

Tangential accuracy correlates relatively strongly with normal singular value and moderately with tangential kinematic conditioning index and tangential minimum singular value. Simulations also clarified difficulties in resecting close to the bladder neck.

CONCLUSIONS

Measures to evaluate accuracy and dexterity of TURBT from a kinematic viewpoint are presented to provide a currently missing quantified dexterity baseline in manual TURBT. Limitations in various bladder regions are illustrated. Copyright © 2016 John Wiley & Sons, Ltd.

Address: Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, 37240, USA.; Vanderbilt Initiative in Surgical Engineering (ViSE), Nashville, Tennessee, USA.; Department of Urologic Surgery, A-1302 Medical Center North, Vanderbilt University Medical Center, Nashville, TN, 37232-2765.; School of Nursing, Vanderbilt University, Nashville, TN, USA.; Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, TN, USA.

DOI: 10.1002/rcs.1757

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MeSH Terms: Biomechanical Phenomena, Computer Simulation, Computer-Aided Design, Cystoscopy, Equipment Design, Equipment Failure Analysis, Hand-Assisted Laparoscopy, Humans, Margins of Excision, Models, Theoretical, Neoplasm Staging, Reproducibility of Results, Robotic Surgical Procedures, Sensitivity and Specificity, Urinary Bladder, Urinary Bladder Neoplasms