Experimental Animal Model for Training Transobturator and Retropubic Sling Techniques

Abstract

Introduction: Suburethral slings have become the treatment of choice for stress urinary incontinence. However, the lack of experimental models for surgical training is a problem for beginners. We present a model for sling training and evaluate its acceptance by surgeons who have had prior experience. Materials and Methods: There were 32 surgeons who performed the training program and filled out a questionnaire to evaluate the animal model. Eleven-month-old Santa Inês sheep were selected. The techniques used for minimally invasive transobturator and retropubic sling implantation were reproduced followed by cystoscopy. The anatomical similarities of sheep and humans were evaluated, in addition to the reproducibility of surgical techniques. Results: As far as anatomical similarities of vaginal structures are concerned, 13 surgeons (40.6%) reported similarities and 18 (56.2%) reported a strong correlation. Concerning cystoscopy, 18 (56.2%) found similarities and 13 (40.6%) a strong similarity. As for the transvaginal sling, 10 (3.1%) reported similarities and 19 (59.3%) a strong similarity. Among those who had previous experience with transobturator slings, 91.6% considered that the model presented a similarity or strong similarity. Regarding the degree of recommendation, 9 surgeons (28.1%) would recommend it and 22 (68.7%) would strongly recommend it. Conclusion: Ninety-seven percent of the surgeons would recommend this experimental model for training purposes. To our knowledge this is the first description of a successful animal model for transobturator sling training.

Preoperative Simulation of Retropubic Midurethral Sling to Decrease Bladder Perforation Rate Among Obstetrics and Gynecology Residents

“…Our results are discordant with previous studies showing that novice surgeons seem to benefit from review of relevant anatomy, using either a model 13 or video demonstration, 11,12 and practice of TVT trocar passage 12,13 . Sabourin et al 12 used a training model similar to ours consisting of watching the manufacturer video for the TVT and subsequently simulating trocar passage with a sling trainer, leading to improvement in written examination results and self-assessment scores.…”

“…A unique contribution of this study is the correlation of an educational intervention with clinical outcomes. Although previous studies have demonstrated that trainees perceive formal surgical educational curricula as helpful, 12,13 our study connected focused preoperative teaching with measurement of the frequency of an intraoperative complication. Additional strengths of our study include simplicity of design and generalizability.…”

“…Although several animal and simulation models have been suggested, there are no data linking these methods to clinical outcomes and thus, limited evidence to support their efficacy. [11][12][13] At our teaching institution, the majority of resident surgical training occurs via direct instruction in the operating room by an attending and/or fellow surgeon, without formal preoperative instruction or simulation. Residents are expected to prepare for cases independently, but self-directed learning may be limited due to lack of a structured curriculum and long work hours.…”

“…The literature describing methods to teach residents the skills required for successful midurethral sling placement is meager. Although several animal and simulation models have been suggested, there are no data linking these methods to clinical outcomes and thus, limited evidence to support their efficacy 11–13 . At our teaching institution, the majority of resident surgical training occurs via direct instruction in the operating room by an attending and/or fellow surgeon, without formal preoperative instruction or simulation.…”

Small Ruminants and Its Use in Regenerative Medicine: Recent Works and Future Perspectives

“…The replacement of a resected bladder segment by biologically inert patches also demonstrated bladder regeneration at the replaced segment, with the presence of fibrous tissue and the growth of new blood vessels in the different histological layers, without decreasing bladder capacity [114]. The sheep has been shown to be particularly appropriate as a surgical model to train trans-obturator and retropubic sling techniques, due to the ease of catheterization and the similarity of the cystoscopy techniques compared to that applied in humans, with the urethral meatuses in the same position, and a trans-obturator access being equivalent despite the smaller diameter [115]. Some preliminary studies also indicate that the intra-arterial application of autologous MSCs in postischemic kidneys promote successful engraftment at the level of renal tubules and glomeruli, although there is still some uncertainty on its reparative effect [116].…”