Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Nov 10;9(11):e112872.
doi: 10.1371/journal.pone.0112872. eCollection 2014.

Tissue quality assessment using a novel direct elasticity assessment device (the E-finger): a cadaveric study of prostatectomy dissection

Daniel W Good  1 , Ashfaq Khan  2 , Steven Hammer  3 , Paul Scanlan  3 , Wenmiao Shu  3 , Simon Phipps  1 , Simon H Parson  2 , Grant D Stewart  1 , Robert Reuben  3 , S Alan McNeill  1
Affiliations

Tissue quality assessment using a novel direct elasticity assessment device (the E-finger): a cadaveric study of prostatectomy dissection

Daniel W Good et al. PLoS One. .

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Picture of the prototype E-finger device.
Figure 2
Figure 2. A Picture showing the grid (Markings) for the assessment of elasticity on an embalmed cadaver.
Figure 3
Figure 3. Histological image (H&E staining) x10 magnification showing bladder smooth muscle tissue.
Figure 4
Figure 4. Boxplots of 15 Hz-AR for prostate and bladder tissue, showing a statistically significant difference (p = 0.014).
Figure 5
Figure 5. Boxplots of 15 Hz-MR for prostate and sphincter tissue, showing a statistically significant difference (p = <0.001).
Figure 6
Figure 6. ROC for 15 node CART model on learn (blue line) and test (red line).
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. (2012) Office of National Statistics.
    1. Ferlay J SH, Bray F, Forman D, Mathers C, Parkin DM (2010) GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. Lyon: International Agency for Research on Cancer.
    1. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, et al. (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59: 61–71. - PubMed
    1. Patel VR, Sivaraman A, Coelho RF, Chauhan S, Palmer KJ, et al. (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59: 702–707. - PubMed
    1. Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, et al. (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62: 405–417. - PubMed

Publication types

LinkOut - more resources