Русский
Using of a dismountable 3D-model of the collecting system with color segmentation to improve the learning curve of residents
DOI: https://dx.doi.org/10.18565/urology.2019.6.21-25
B.G. Guliev, B.K. Komyakov, A.E. Talyshinskiy, E.O. Stetsik
1) Department of urology (Head – prof. B.K. Komyakov) of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia; 2) Center of Urology with robot-assisted surgery of City Mariinsky hospital (chief – prof. Emelyanov O.V.), Saint Petersburg, Russia
Aim: to determine the efficiency of using a non-biological dismountable 3D-model of the collecting system with color segmentation for better understanding of its anatomy by residents and to determine the optimal tactics of percutaneous nephrolithotomy (PNL).
Materials and methods. 3D-models of the collecting system were developed based on CT data of 5 patients with staghorn stones, for whom PNL was planned. CT images were obtained in the Dicom format. RadiAnt DICOM Viewer was used for delineation and segmentation of the collecting system with 3D visualization. Using slicer 4.8.1 software, virtual models were processed to convert DICOM files to STL format. Then, virtual color extraction of each group of calyxes was performed for convenient disassembling and intraluminal study of the anatomy of the collecting system. The final stage included the printing of each area by the method of layer-by-layer deposition using a 3D printer Picaso designer X. To assess the efficiency of the dismountable 3D-model that simulates a certain collecting system, a questionnaire was used. It allowed to evaluate the understanding of the anatomy of the collecting system by residents, as well as the ability to determine the optimal calyx for PNL by comparing the answers with the result of a survey of practicing urologists who had performed more than 50 cases.
Results. After studying 3D-models by residents, determination of the number of calyxes in each group was not statistically significantly different from those for practicing urologists who used CT images. The choice of the calyx for primary puncture was not different between groups. However, residents chose the calyx for additional access worse (p=0.009).
Conclusion. The dismountable 3D-model of the collecting system is promising for training of residents and planning PNL. Studying the anatomy of a single group of calyxes as well as the entire collecting system allows to choose the optimal calyx for percutaneous puncture during PNL.
Materials and methods. 3D-models of the collecting system were developed based on CT data of 5 patients with staghorn stones, for whom PNL was planned. CT images were obtained in the Dicom format. RadiAnt DICOM Viewer was used for delineation and segmentation of the collecting system with 3D visualization. Using slicer 4.8.1 software, virtual models were processed to convert DICOM files to STL format. Then, virtual color extraction of each group of calyxes was performed for convenient disassembling and intraluminal study of the anatomy of the collecting system. The final stage included the printing of each area by the method of layer-by-layer deposition using a 3D printer Picaso designer X. To assess the efficiency of the dismountable 3D-model that simulates a certain collecting system, a questionnaire was used. It allowed to evaluate the understanding of the anatomy of the collecting system by residents, as well as the ability to determine the optimal calyx for PNL by comparing the answers with the result of a survey of practicing urologists who had performed more than 50 cases.
Results. After studying 3D-models by residents, determination of the number of calyxes in each group was not statistically significantly different from those for practicing urologists who used CT images. The choice of the calyx for primary puncture was not different between groups. However, residents chose the calyx for additional access worse (p=0.009).
Conclusion. The dismountable 3D-model of the collecting system is promising for training of residents and planning PNL. Studying the anatomy of a single group of calyxes as well as the entire collecting system allows to choose the optimal calyx for percutaneous puncture during PNL.
Keywords: 3D-modeling, collecting system, renal stones, urinary stone disease, percutaneous nephrolithotomy, treatment
About the Autors
Corresponding author: B.G. Guliev– MD, professor at the Department of urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Head of Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia; e-mail: gulievbg@mail.ru
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