Tissue quality assessment using a novel direct elasticity assessment device (the e-finger)

a cadaveric study of prostatectomy dissection

Daniel W. Good, Ashfaq Khan, Steven Hammer, Paul Scanlan, Wenmiao Shu, Simon Phipps, Simon H. Parson, Grant D. Stewart, Robert Reuben, S. Alan McNeill

Research output: Contribution to journalArticle

7 Citations (Scopus)
20 Downloads (Pure)

Abstract

Introduction
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.
Material and Methods
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.
Results
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.
Conclusions
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.
Original languageEnglish
Article number112872
Number of pages8
JournalPLOS One
Volume9
Issue number11
DOIs
Publication statusPublished - 10 Nov 2014

Fingerprint

Dissection
Elasticity
Prostatectomy
elasticity (mechanics)
Fingers
Tissue
Equipment and Supplies
Prostate
bladder
Cadaver
Urinary Bladder
Robotics
Surgery
Feedback
sphincters
laparoscopy
Histology
surgeons
Degrees of freedom (mechanics)
Hematoxylin

Keywords

  • assisted radical prostatectomy
  • metaanalysis
  • cancer
  • surgery

Cite this

Good, Daniel W. ; Khan, Ashfaq ; Hammer, Steven ; Scanlan, Paul ; Shu, Wenmiao ; Phipps, Simon ; Parson, Simon H. ; Stewart, Grant D. ; Reuben, Robert ; McNeill, S. Alan. / Tissue quality assessment using a novel direct elasticity assessment device (the e-finger) : a cadaveric study of prostatectomy dissection. In: PLOS One. 2014 ; Vol. 9, No. 11.
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title = "Tissue quality assessment using a novel direct elasticity assessment device (the e-finger): a cadaveric study of prostatectomy dissection",
abstract = "IntroductionMinimally 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.Material and MethodsTwo 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.ResultsStatistically 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.ConclusionsThis 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.",
keywords = "assisted radical prostatectomy, metaanalysis, cancer, surgery",
author = "Good, {Daniel W.} and Ashfaq Khan and Steven Hammer and Paul Scanlan and Wenmiao Shu and Simon Phipps and Parson, {Simon H.} and Stewart, {Grant D.} and Robert Reuben and McNeill, {S. Alan}",
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Good, DW, Khan, A, Hammer, S, Scanlan, P, Shu, W, Phipps, S, Parson, SH, Stewart, GD, Reuben, R & McNeill, SA 2014, 'Tissue quality assessment using a novel direct elasticity assessment device (the e-finger): a cadaveric study of prostatectomy dissection', PLOS One, vol. 9, no. 11, 112872. https://doi.org/10.1371/journal.pone.0112872

Tissue quality assessment using a novel direct elasticity assessment device (the e-finger) : a cadaveric study of prostatectomy dissection. / Good, Daniel W.; Khan, Ashfaq; Hammer, Steven; Scanlan, Paul; Shu, Wenmiao; Phipps, Simon; Parson, Simon H.; Stewart, Grant D.; Reuben, Robert; McNeill, S. Alan.

In: PLOS One, Vol. 9, No. 11, 112872, 10.11.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Tissue quality assessment using a novel direct elasticity assessment device (the e-finger)

T2 - a cadaveric study of prostatectomy dissection

AU - Good, Daniel W.

AU - Khan, Ashfaq

AU - Hammer, Steven

AU - Scanlan, Paul

AU - Shu, Wenmiao

AU - Phipps, Simon

AU - Parson, Simon H.

AU - Stewart, Grant D.

AU - Reuben, Robert

AU - McNeill, S. Alan

PY - 2014/11/10

Y1 - 2014/11/10

N2 - IntroductionMinimally 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.Material and MethodsTwo 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.ResultsStatistically 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.ConclusionsThis 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.

AB - IntroductionMinimally 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.Material and MethodsTwo 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.ResultsStatistically 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.ConclusionsThis 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.

KW - assisted radical prostatectomy

KW - metaanalysis

KW - cancer

KW - surgery

UR - http://journals.plos.org/plosone/

U2 - 10.1371/journal.pone.0112872

DO - 10.1371/journal.pone.0112872

M3 - Article

VL - 9

JO - PLOS One

JF - PLOS One

SN - 1932-6203

IS - 11

M1 - 112872

ER -