Construct Validity of the Pig Intestine Model in the Simulation of Laparoscopic Urethrovesical Anastomosis: And Tools for Objective Evaluation

Boon, John R.; Salas, Nilson A.; Avila, Desiderio; Lipshultz, Larry I.; Boone, Timothy B.; Link, Richard E.

doi:10.1016/s0022-5347(08)61927-8

Cited by 4 publications

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“…Another model used for laparoscopic UVA is the porcine intestine model, which was also shown to have construct validity in the study carried out by Boon et al. . Jiang et al.…”

Section: Resultsmentioning

confidence: 99%

Simulation‐based training for prostate surgery

et al. 2015

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A review of the literature between 1999 and 2014 was performed. The search terms included a combination of urology, prostate surgery, robotic prostatectomy, laparoscopic prostatectomy, transurethral resection of the prostate (TURP), simulation, virtual reality, animal model, human cadavers, training, assessment, technical skills, validation and learning curves. Furthermore, relevant abstracts from the American Urological Association, European Association of Urology, British Association of Urological Surgeons and World Congress of Endourology meetings, between 1999 and 2013, were included. Only studies related to prostate surgery simulators were included; studies regarding other urological simulators were excluded. ResultsA total of 22 studies that carried out a validation study were identified. Five validated models and/or simulators were identified for TURP, one for photoselective vaporisation of the prostate, two for holmium enucleation of the prostate, three for laparoscopic radical prostatectomy (LRP) and four for robotassisted surgery. Of the TURP simulators, all five have demonstrated content validity, three face validity and four construct validity. The GreenLight laser simulator has demonstrated face, content and construct validities. The Kansai HoLEP Simulator has demonstrated face and content validity whilst the UroSim HoLEP Simulator has demonstrated face, content and construct validity. All three animal models for LRP have been shown to have construct validity whilst the chicken skin model was also content valid. Only two robotic simulators were identified with relevance to robot-assisted laparoscopic prostatectomy, both of which demonstrated construct validity. ConclusionsA wide range of different simulators are available for prostate surgery, including synthetic bench models, virtual-reality platforms, animal models, human cadavers, distributed simulation and advanced training programmes and modules. The currently validated simulators can be used by healthcare organisations to provide supplementary training sessions for trainee surgeons. Further research should be conducted to validate simulated environments, to determine which simulators have greater efficacy than others and to assess the cost-effectiveness of the simulators and the transferability of skills learnt. With surgeons investigating new possibilities for easily reproducible and valid methods of training, simulation offers great scope for implementation alongside traditional methods of training.

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“…Another model used for laparoscopic UVA is the porcine intestine model, which was also shown to have construct validity in the study carried out by Boon et al. . Jiang et al.…”

Section: Resultsmentioning

confidence: 99%

Simulation‐based training for prostate surgery

et al. 2015

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“…Anastomotic leakage was observed at different locations, including dorsal, ventral, and lateral aspects of VUA. Previous authors have reported the dorsal aspect of VUA to be the most prevalent site for leakage because of challenges encountered with exposure and visualizing of the dorsal aspect of the bladder neck 23‐25 . Excessive tension exerted during suturing the dorsal side to bring the bladder to the urethra can induce tearing of the tissue, increasing the incidence of urine leakage from the dorsal aspect, especially when the animal is in Trendelenburg position 23‐25 .…”

Section: Discussionmentioning

confidence: 99%

“…The main difficulties were related to knot tying, needle handling, accurate placement of suture bites, and angle of suturing between the bladder neck and the urethra 26‐28 . Suturing time was also longer in the I group because of the difficulties in visualizing the dorsal lip of the bladder neck during suturing of the dorsal side of the anastomosis 23‐25 …”

Section: Discussionmentioning

confidence: 99%

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue

2021

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Objective To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue. Study design Cadaveric ex vivo study. Study population Twenty‐eight canine bladders with urethra. Methods Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4–0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded. Results Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3–39.2) for the I group and 17.3 minutes (range, 9.2–21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1–29.7) for the I group and 10.8 mm Hg (range, 6.2–18.5) for the C group (P = .94). The median number of stitches was 20 (range, 14–26) for the I group and 19 (range, 11–28) for the C group (P = .96). The distribution of the site of leakage was similar between groups (P = .381). Conclusion Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing. Clinical significance This study represents the first step toward laparoscopic radical prostatectomy in dogs.

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“…By comparison, current ex vivo models for minimally invasive radical prostatectomy training are mainly tissue‐based , and have mainly focused only on practising UVA or nerve‐sparing components . Alemozaffar et al presented the only procedural tissue‐based simulator similar to our platform that allows the practice of NS‐RARP in sequential fashion.…”

Section: Discussionmentioning

confidence: 99%

Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full‐immersion simulation platform for nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP) utilizing three‐dimensional printing and hydrogel casting technology

et al. 2019

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ObjectivesTo incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Materials and MethodsAnatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into threedimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. Incorporating clinical metrics in a RARP model sparing radical prostatectomy and fruit for simple prostatectomy. Korean J Urol 2011; 52: 130-5 34 Clarebrough E, Christidis D, Lindner U, Fernandes K, Fleshner N, Lawrentschuk N. Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy. World J Urol 2019; 37: 799-804

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Construct Validity of the Pig Intestine Model in the Simulation of Laparoscopic Urethrovesical Anastomosis: And Tools for Objective Evaluation

Cited by 4 publications

References 0 publications

Simulation‐based training for prostate surgery

Simulation‐based training for prostate surgery

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue

Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full‐immersion simulation platform for nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP) utilizing three‐dimensional printing and hydrogel casting technology

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