Robot‐assisted radical prostatectomy training: Description of a canine cadaveric model

Abstract

Background Assess the relevance of a canine model in robot‐assisted radical prostatectomy (RARP) training. Methods Step‐by‐step RARP was performed in five dog cadavers using a Da Vinci Si® Surgical Robot (Intuitive Surgical, Inc.). The steps were defined according to the RARP score, a validated training tool describing 17 key steps and four levels of difficulty; each step was scored to reflect the anatomical and technical similarities, realism of dissection, and face validity of the canine model compared to the human procedure. Results Fourteen steps were performed during each procedure. Face validity was scored as high or very high for five of the nine steps of difficulty levels 1 and 2 as well as five of the eight steps of difficulty levels 3 and 4, especially nerve preservation, vesicourethral anastomosis and lymph node dissection. Conclusions The cadaveric canine model seems to be a realistic and relevant training model for key steps of RARP.

Virtual reality vs. physical models in surgical skills training. An update of the evidence

“…There is a paucity of VR simulators in areas such as emergency urology and reconstructive urology, although existing physical models appear to be adequate in addressing the educational needs of trainees. For the other urological fields, concomitant use of VR and physical simulators is beneficial given the skill transferability [ 24 ] and additive effect they have [ 11 ]. The type of simulator to be used is also dependent upon whether full procedural simulation or task-based simulation is required, with VR and cadavers generally being the better options for the former and with ‘dry-lab’ bench models being more cost-effective for the latter.…”

“…This has been demonstrated for RARP [ 23 ] with superior performance on a FFC being noted for trainees who underwent procedural training over those who only underwent basic VR training or no training at all. Similarly, a canine cadaver model [ 24 ] demonstrated face validity for procedural simulation of RARP, particularly for the nerve preservation, vesicourethral anastomosis and lymph node dissection steps. One comparative paper [ 24 ] sought to compare skill transferability between VR and dry laboratory simulation environments using vesico-urethral anastomosis tasks.…”

“…Similarly, a canine cadaver model [ 24 ] demonstrated face validity for procedural simulation of RARP, particularly for the nerve preservation, vesicourethral anastomosis and lymph node dissection steps. One comparative paper [ 24 ] sought to compare skill transferability between VR and dry laboratory simulation environments using vesico-urethral anastomosis tasks. The performance metrics used exhibited moderate to strong correlations between the two modalities, thereby indicating skill transferability.…”

Description of the technique for laparoscopic radical prostatectomy in canine cadavers: 2D vs. 3D camera

“…The Denonvilier’s facia is usually sutured to the posterior wall of the bladder before starting the VUA in human patients [ 16 , 19 ]. This step was not required to bring the bladder closer to the urethra during our cadaveric study and was not performed during robotic prostatectomy in canine cadavers [ 9 ]. However, in human patients, suturing the fascia to the bladder might reduce the risk of extravasation of urine in the abdominal cavity in the postoperative period [ 20 ].…”

“…Laparoscopy is beneficial and more practical for ablating small organs that are difficult to reach during the open approach. Robotic radical prostatectomy has been performed successfully in one client-owned dog and described in three canine cadavers [ 8 , 9 ]. Robots are not readily available in veterinary surgery yet.…”