Cost-Effective and Readily Replicable Surgical Simulation Model Improves Trainee Performance in Benchtop Robotic Urethrovesical Anastomosis

Abstract

Introduction:Our objective was to develop a simple, cost-effective and reusable model for urethrovesical anastomosis for robotic-assisted radical prostatectomy and evaluate its impact on fundamental surgical skills and confidence of urology trainees.Methods:A model for the bladder, urethra and bony pelvis was created from materials easily purchased online. Each participant performed several trials of urethrovesical anastomosis using the da Vinci Si® surgical system. Pre-task confidence was assessed prior to each attempt. Two blinded researchers measured the following outcomes: time-to-anastomosis, number of suture throws, perpendicular needle entry and atraumatic needle driving. Integrity of the anastomosis was estimated by gravity filling and measuring pressure at which leakage occurred. These outcomes were translated into an independently validated Prostatectomy Assessment Competency Evaluation score.Results:The model took 2 hours to create and total cost was 64 U.S. dollars. Twenty-one residents enrolled and demonstrated significant improvement in time-to-anastomosis, perpendicular needle driving, anastomotic pressure and total Prostatectomy Assessment Competency Evaluation score between the first and third trial. Pre-task confidence was measured on a Likert scale (1–5) and improved significantly over the 3 trials (Likert scale of 1.8, 2.8 and 3.3).Conclusions:We developed a cost-effective model of urethrovesical anastomosis that does not require the use of a 3D printer. This study demonstrates significant improvement of fundamental surgical skills and validated surgical assessment score for urology trainees over 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.

Simulation and Training in Robot-Assisted Urological Surgery: From Model to Patient

“…Synthetic organ models—Efforts have been ongoing for some time to replace live animal and cadaver surgery with various physical models being developed, including those made from artificial materials like sponges, tubes, 3D-printed models, and tissue-based models [ 20 , 21 ]. Their limitations include a lack of anatomical precision, limited haptic feedback, inadequate color accuracy and similarity, lack of electrosurgical functionality, and absence of bleeding simulation [ 22 ].…”

Computer Vision and Machine-Learning Techniques for Automatic 3D Virtual Images Overlapping During Augmented Reality Guided Robotic Partial Nephrectomy

“…3D models find their application in a large number of scenarios, starting from the pre-surgical discussion of a clinical case (eg, complex renal mass) to training for novice surgeons, 10 – 12 to intraoperative navigation. 13 …”