Project could increase affordable training for kidney cancer surgeons

Issued: Sun, 25 Aug 2019 15:54:00 BST

Lisa Ferrie full size

Future kidney cancer surgeons could benefit from increased training opportunities as a result of an innovative research project undertaken by Lisa Ferrie, a Medical Visualisation and Human Anatomy masters student.

Lisa said: "There is an increasing incidence of kidney cancer within the UK and where possible surgeons will use a procedure known as a partial nephrectomy to treat it.

"The procedure removes only the part of the kidney affected by the tumour, which is done to preserve as much kidney function as possible while still removing the cancer. This procedure is very technically challenging and can only be performed by a few very skilled surgeons."

Lisa has developed an approach that could help trainee surgeons access a low-cost means of learning and continually developing the skills required to perform a robot-assisted laparoscopic partial nephrectomy. This could ultimately generate a bigger pool of capable surgeons and thus widen access to the best available care for patients.

Starting with a CT scan from a patient who had kidney cancer, Lisa used 3D-printing technology to develop and evaluate an anatomically accurate, low-cost surgical training model of a kidney with a tumour. Anatomically accurate 3D moulds are printed which are then filled with hydrogels capable of simulating human tissue. Surgeons and trainees can then use the model to hone their skills in robotic surgery.

Lisa explained: “I had always intended to apply the knowledge and skills I’ve acquired from the Medical Visualisation and Human Anatomy programme of study to the field of clinical medicine.

"I have a background in medical sciences and have developed a passion for improving medical education, clinical practice and patient care through the application of technology.”

"The decision to focus on kidney cancer and the development of a surgical training model for robot-assisted laparoscopic partial nephrectomy was due to both my academic interest in the kidney and because the disease has personally affected my family.”

Lisa worked closely with leading expert Mr Grenville Oades, Consultant Urological Surgeon, and Miss Flora Rodger, Urology Specialist Registrar at the Queen Elizabeth University Hospital, as well as Álvaro Sánchez-Rubio, Biomedical Engineering PhD Candidate based in the Centre for the Celullar Microenvironment.

Mr Oades added: “Complex operations such as Robotic Assisted Laparoscopic Partial Nephrectomy (RALPN) are difficult to learn.

"Traditional models of surgical training by apprenticeship are being challenged due to time constraints, pressures to deliver consultant lead services and the ever-increasing complexity of modern medicine.”

One of the key recommendations of the current national pilot for improving surgical training is that 'simulation should be embedded and enhanced within the surgical curricula and there should be sufficient resource to ensure availability for all trainees.'

Currently, this type of training in robotic surgery is provided by virtual reality simulators as well as cadaveric and animal models. These are expensive, time consuming and not widely available.

Mr Oades added: “What is proposed by Lisa is a simple, low cost model of RALPN that could easily be incorporated into surgical training.

"The model looked and felt real. It provided an excellent way to practise secondary renorrhaphy, and I was impressed how the passing of sutures through the simulated renal capsule and closing of the defect mimicked an actual operation. The silicone moulded artery also behaved in a realistic fashion when clamped.”

“Overall I thought this model provided an excellent opportunity to practice a complex surgical technique in a non-virtual reality environment and would be very keen to incorporate it into surgical training.”

Flora Rodger said: “As a junior surgical trainee there are limited opportunities to gain exposure to sub-specialist skills such as robotic surgery.

"This realistic model provides a safe environment to develop skills in robotic surgery that would otherwise be reserved for later stages of training.

"It also allows you to get a feel for the instruments and tissue handling in a way that online modules struggle to recreate. As robotic surgery becomes more widely used in urology this type of model will be invaluable.”

Paul Rea, University of Glasgow professor of Digital and Anatomical Education, said: "I am delighted to see such revolutionary technology developed in partnership with Mr Grenville Oades, Consultant Urological Surgeon, Queen Elizabeth University Hospital and his team.

"Lisa is a student on the MSc Medical Visualisation and Human Anatomy programme, a joint degree offered by the School of Life Sciences in collaboration and partnership with the School of Simulation and Visualisation at The Glasgow School of Art.

"This work truly demonstrates the amazing innovation 3D printing could potentially offer for surgical training, robotic surgery and surgical planning."

Lisa concluded: “I would love to take this research forward and develop and improve the model. I think effective, low-cost surgical training models could widen access to surgical training opportunities that mayotherwise be inaccessible due to the related high costs.

"Ultimately through the development and increase in surgical skills there will be consequential improvement in patient care.”

Lisa Ferrie’s work will be on show at GSA Graduate Degree Show in McLellan Galleries from 23 – 29 August. Open daily: Mon - Thurs 10am – 8pm Sat - Sun 10am – 6pm. Entry free