Last updated: 5/9/14 9:44pm

This project surrounds the topic of implementing a blood vessel and tissue dissection simulation as well as a model for robotic surgery training. Further sub-topic will include the study of blood vessel histology as well as exploring and experimenting with synthetic biomaterial replication of human tissue and vasculature. Additionally, this project will incorporate and require a development of a basic understanding of energy-cutting electrosurgery and electrocoagulation. The goal of this project is to create an inanimate surgical training model for both sharp and blunt tissue dissection as well as blood vessel energy-cutting that is ultimately cheap, effective, potentially reusable, and long-lasting. User feedback from currently practicing surgeons through the Minimally Invasive Surgical Training and Innovation Center (MISTIC) will be incorporated to further develop a comprehensive dissection and energy-cutting model for future robotic surgery training.

• Students: Shayer Chowdhury
• Mentor(s): Dr. Gyusung Lee (glee59@jhmi.edu)

• Robotic surgeons have expressed a desire to spend more time on blood vessel dissection preparation
• Want to practice different techniques: blunt dissection, sharp dissection, and electrocoagulation
• Current practice models run up to $75-80 and are not reusable
• Want a realistic phantom training model, but one that is also cheap and efficient to make, and potentially reusable
• Current state: Lack of a cheap, effective, and reusable blood vessel dissection phantom for robotic surgery training
• Approach: Model creation, then frequent updating and testing through user feedback with surgeons at JHMI
• Goal: Create a comprehensive inanimate surgical training model for sharp/blunt dissection and blood vessel electrocoagulation

• Minimum: Expected date: March 20th
  1. Blunt/sharp dissection model prototype
  2. Below is a picture of the current blunt/sharp model prototype
  3. Involves cotton stuffing to simulate the elasticity of tissue and rubber bands to simulate blood vessels
  4. Cheap and reusable; currently receiving feedback from surgeons and further evaluation and searching for more effective materials

• Expected: Expected date: April 1st April 21st
  1. Modified and improved blunt/sharp dissection model with user feedback and experimentation with other materials
  2. Electrocoagulation model prototype
  3. Modified expected date
  4. Below is a picture of the current electrosurgery model prototype
  5. Involves silicone rubber tubing embedded in gelatine from porcine skin ordered from Sigma-Aldrich
  6. Currently in evaluation and feedback and searching for more effective additions

• Maximum: Expected date: May 7th
  1. Completed blunt/sharp dissection and electrocoagulation models
  2. Integration into future standard robotic surgery training practicums
  3. Production and storage of models for future planned usage

A significant amount of time will be spent collaborating with robotic surgery educators in the MISTIC program at the JHMI. We hope to begin by gauging interest and understanding the process of developing a more realistic physical blood vessel dissection model. We then will proceed to evaluate shortcomings of current models and use them as a basis from where we can develop a more successful model. The next step will be to search for different potential material and media to use for the phantom tissue creation, including gelatin, plastisol, silicone gel, latex, and even cotton stuffing. Additionally, we will evaluate each medium based on its cost, its effectiveness in replicating human tissue, and its potential to be reusable and to be long lasting. At the same time, we will proceed to search for tubing material that is conductive enough so that it will behave similar to a vessel in an energy-cutting model in terms of coagulation and dissection. From there, we will create a blunt/sharp dissection model that focuses on maintaining realistic surrounding tissue and an energy-cutting model that focuses on realistic blood vessel coagulation. We then will proceed to test and observe how our model behaves by allowing practicing surgeons to use them. Afterwards, we will document the results and evaluate user feedback in order to modify the prototypes. Currently, we have developed a prototype for the blunt/sharp dissection model and are undergoing feedback and evaluation through surgeons at MISTIC. We aim to get the electrosurgery model under evaluation soon as well.

- Access to mentors

• Weekly meetings with Dr. Gyusung Lee
• Status: Achieved - Weekly meetings on Friday

- Access to lab space to create phantom media

• Available lab space at MISTIC at the JHMI (12th floor of Blalock)
• MISTIC will also be used as headquarters and main address for delivery of materials
• Status: Achieved

- Cost to afford material

• Material will be fairly inexpensive, since cheap and efficient is our goal anyways
• Dr. Lee is in the process of obtaining a small grant to fund the project
• Attempt to use recyclable lab material
• Status: Achieved - I will buy materials and Dr. Lee will reimburse me

- Access to relevant literature

• Articles available online and at the MSE Library
• Status: Achieved

- Access to surgeons who are willing to practice on and evaluate the effectiveness of the model prototypes

• Dr. Lee will arrange and work with surgeons at MISTIC who will participate in testing out prototypes and commenting on shortcomings and successes
• Status: Achieved - Still have limited access depending on surgeons' schedules, so modifying expected dates accordingly.

1. Milestone date: March 7th
   • Finish discussion with surgeons regarding current models
   • Familiarization with current models and production of phantom materials
   • Status: Achieved
2. Milestone date: March 20th
   • Creation of first blunt/sharp dissection model prototype
   • Status: Achieved
3. Milestone date: April 1st April 21st
   • Obtain user feedback from surgeons on blunt/sharp model
   • Creation of first electrocoagulation dissection model prototype
   • Status: Achieved
4. Milestone name: April 15th May 1st
   • Continue modifying blunt/sharp dissection model
   • Obtain user feedback from surgeons on electrocoagulation model
   • Status: Achieved
5. Milestone name: May 4th
   • Continued modification and optimization of models
   • Status: Achieved
6. Milestone name: May 9th
   • Poster presentation and final report
   • Status: Achieved

• Project Plan
  • project_presentation_2-24_shayer_chowdhury.pptx
  • cis_ii_project_proposal_-_shayer_chowdhury_final.pdf
• Project Background Reading
  • See Bibliography below for links.
• Project Checkpoint
  • cis2_checkpoint_presentation.pptx
• Paper Seminar Presentations
  • article_review.docx
• Project Final Presentation
  • project_3_poster_-_shayer_chowdhury.ppt
• Project Final Report
  • final_report_-_shayer_chowdhury_-_project_3.docx
• Lab Safety Certificate
  • schowdh8_labcertificate.pdf

• C Schneider, C Kut, N Carter-Monroe, Creation of Ultrasound Elastography Phantoms
• GI Lee, MR Lee, T Clanton, E Sutton, AE Park, MR Marohn, Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries
• DS Kopac, J Chen, R Tang, A Sawka, H Vaghadia, Comparison of a novel real-time SonixGPS needle-tracking ultrasound technique with traditional ultrasound for vascular access in a phantom gel model
• KB Lawrenson, FO Stephens, The Use of Electrocutting and Electrocoagulation in Surgery
• T Diamantis, M Kontos, A Arvelakis, S Syroukis, D Koronarchis, A Papalois, E Agapitos, E Bastounis, AC Lazaris, Comparison of monopolar electrocoagulation, bipolar electrocoagulation, Ultracision, and Ligasure.
• K Charoenkwan, N Chotirosniramit, K Rerkasem, Scalpel versus electrosurgery for abdominal incisions
• IA Hein, WD O'Brien, A flexible blood flow phantom capable of independently producing constant and pulsatile flow with a predictable spatial flow profile for ultrasoundflow measuremeant validations
• BL Hainer, Fundamentals of Electrosurgery

Here give list of other project files (e.g., source code) associated with the project. If these are online give a link to an appropriate external repository or to uploaded media files under this name space.