Catheter associated urinary tract infections (CAUTI) are among the most common nonpayment hospital acquired conditions. Inexperienced health care providers placing indwelling urinary catheters are associated with an increased risk of CAUTI. The creation of high-fidelity simulators may reduce CAUTI risk during critical early learning. As a first step toward the creation of accurate simulators our group set out to characterize the mechanical aspects of urethral catheterization. This work presents an inexpensive, yet practical means of acquiring motion and force data from urethral catheter insertion procedures using OpenCV ArUco markers. Evaluation of the video system’s accuracy was done to understand the performance characteristics within the boundaries of the procedure’s target workspace. The tracking accuracy was validated to be roughly ± 3 mm in the plane of the camera, and ± 10–25 mm along its axis depending on the distance. Feasibility of using this platform in a clinically relevant setting was demonstrated by capturing the force and motion data when performing urinary catheterization on cadaveric donors (N=2).

With medical institutions increasing the use of medical simulators for educational purposes it is detrimental that the knowledge gap regarding tissue mechanical properties be researched further in depth. The grasper device discussed throughout this paper aims to provide researchers a handheld device capable of testing soft organs and tissue in-vivo and ex-situ in a laboratory setting. The device consists of two load cells on the inner jaws of the grasper to measure compressive force and an encoder to monitor the graspers angular position which yields tissue position and strain. Accompanying the grasper is a GUI written in Rust which is capable of data file management, and providing a 10 second live feed of load cell and encoder readings. The grasper device is currently being employed in a study testing the tissue mechanical response of porcine tissue at states ranging from in-vivo to ex-situ post freeze. The results from this test, and subsequent tests using the grasper have the capability of providing much needed knowledge regarding tissue mechanical properties to improve medical simulators and medical education as a whole.

Background Healthcare simulators have been demonstrated to be a valuable resource for training several technical and nontechnical skills. A gap in the fidelity of tissues has been acknowledged as a barrier to application for current simulators; especially for interventional procedures. Inaccurate or unrealistic mechanical response of a simulated tissue to a given surgical tool motion may result in negative training transfer and/or prevents the “suspension of disbelief” necessary for a trainee to engage in the activity. Thus, where it is relevant to training outcomes, there should be an effort to create healthcare simulators with simulated tissue mechanical responses that match or represent those of biological tissues. Historically, this data is most often gathered from preserved (post mortem) tissue; however, there is a concern that the mechanical properties of preserved tissue, that lacks blood flow, may lack adequate accuracy to provide the necessary training efficacy of simulators. Methods and findings This work explores the effect of the “state” of the tissue testing status on liver and peritoneal tissue by using a customized handheld grasper to measure the mechanical responses of representative porcine (Sus domesticus) tissues in n = 5 animals across five test conditions: in vivo, post mortem (in-situ), ex vivo (immediately removed from fresh porcine cadaver), post-refrigeration, and post-freeze-thaw cycle spanning up to 72 hours after death. No statistically significant difference was observed in the mechanical responses due to grasping between in vivo and post-freeze conditions for porcine liver and peritoneum tissue samples (p = 0.05 for derived stiffness at grasping force values F = 5N and 6.5N). Furthermore, variance between in vivo and post-freeze conditions within each animal, was comparable to the variance of the in vivo condition between animals. Conclusions Results of this study further validate the use of preserved tissue in the design of medical simulators via observing tissue mechanical responses of post-freeze tissue comparable to in vivo tissue. Therefore, the use of thawed preserved tissue for the further study and emulation of mechanical perturbation of the liver and peritoneum can be considered. Further work in this area should investigate these trends further, particularly in regard to other tissues and the potential effects varying preservation methods may yield.

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Healthcare simulators have been demonstrated to be a valuable resource for training several technical and nontechnical skills. A gap in the fidelity of tissues has been acknowledged as a barrier to application for current simulators; especially for interventional procedures. Inaccurate or unrealistic mechanical response of a simulated tissue to a given surgical tool motion may result in negative training transfer and/or prevents the “suspension of disbelief” necessary for a trainee to engage in the activity. Thus, where it is relevant to training outcomes, there should be an effort to create healthcare simulators with simulated tissue mechanical responses that match or represent those of biological tissues. Historically, this data is most often gathered from preserved (post mortem) tissue; however, there is a concern that the mechanical properties of preserved tissue, that lacks blood flow, may lack adequate accuracy to provide the necessary training efficacy of simulators. This work explores the effect of the “state” of the tissue testing status on liver and peritoneal tissue by using a customized handheld grasper to measure the mechanical responses of representative porcine (Sus domesticus) tissues in N=5 animals across five test conditions: in vivo, postmortem (in-situ), ex vivo (immediately removed from fresh porcine cadaver), post-refrigeration, and post-freeze-thaw cycle spanning up to 72 hours after death. No statistically significant difference was observed in the mechanical responses due to grasping between in vivo and post-freeze conditions for porcine liver and peritoneum tissue samples (p = 0.05 for derived stiffness at grasping force values F = 5N and 6.5N). Furthermore, variance between in vivo and post-thaw conditions within each animal, was comparable to the variance of the in vivo condition between animals. Thus, the use of thawed, preserved tissue for the further study and emulation of mechanical perturbation of the liver and peritoneum can be considered.