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UPJ INSIGHT Cost-Effective and Readily Replicable Surgical Simulation Model Improves Trainee Performance in Benchtop Robotic Urethrovesical Anastomosis
By: Stacy Jeong, MD; Maxx Caveney, MD; Jacob Knorr, MD; Rebecca Campbell, MD; Daniel Santana, MD; Christopher Weight, MD; Nima Almassi, MD; Steven Campbell, MD, PhD | Posted on: 01 Sep 2022
Jeong S, Caveney M, Knorr J, et al: Cost-effective and readily replicable surgical simulation model improves trainee performance in benchtop robotic urethrovesical anastomosis. Urol Pract. 2022;9(5)504-511.
Study Need and Importance
Robotic-assisted radical prostatectomy is a commonly performed yet challenging procedure for residents to master. One of the most difficult steps of robotic-assisted radical prostatectomy is the urethrovesical anastomosis (UVA). With increasing nonsurgical responsibilities and thus limited training opportunities in the operating room, residents may benefit from procedural simulation to achieve competency for these surgical skills. In this study, we developed a cost-effective, reusable surgical model of the UVA and evaluated its impact on resident surgical skills over multiple sessions.
What We Found
Our model required 2 hours to create utilizing materials easily obtained online with a cost of $64 (see Figure). Residents demonstrated significant improvements in time-to-anastomosis, perpendicular needle handling and anastomotic pressure withstood by the UVA. There was also a significant improvement in an independently validated Prostatectomy Assessment Competency Evaluation score. Pre-task confidence was measured on a Likert scale and improved significantly over the 3 trials.
Limitations
Our sample size was limited to 21 residents, although statistical significance was still observed for several metrics. Another limitation is the use of silicone as replacement for human tissue. While silicone cannot entirely replicate natural tissue, it is a durable and cost-effective alternative, and most trainees believed it was a good substitute. Finally, we cannot translate improvement in Prostatectomy Assessment Competency Evaluation score into actual surgical performance. However, considering that our model involves use of a real suture and space constraints, it has potential to improve the learning curve in the operating room.
Interpretation for Patient Care
Our model for UVA was cost-effective, reusable and easily reproducible. Residents demonstrated significant improvements of fundamental surgical skills, validated surgical assessment score and confidence after several trials. Our model shows potential for increasing accessibility of robotic training models for urological education. Additional investigation will be required to further assess the utility and validity of this model. STOP