Simulation Training in Penile Implant Surgery: Assessment of Surgical Confidence and Knowledge With Cadaveric Laboratory Training

Abstract

IntroductionConstraints on surgical resident training (work-hour mandates, shorter training programs, etc.) and availability of expert surgical educators may limit the acquisition of prosthetic surgical skills. As a result, training courses are being conducted to augment the prosthetic surgery learning experience.AimTo evaluate the impact of a hands-on cadaver-based teaching program on resident procedural knowledge and procedural confidence with placement of a penile prosthesis.Main Outcome MeasureChanges in procedural knowledge and self-confidence following a focused training program on penile prosthetics.MethodsAs part of the 2017 Society of Urologic Prosthetic Surgeons and the Sexual Medicine Society of North America Annual Meeting, 31 urology residents participated in a simulation lab in prosthetic urology. The lab included didactic lectures and a hands-on cadaveric laboratory. Participants completed surveys before and after the course. Wilcoxon Signed Rank tests for matched pairs were used to compare respondents’ pre- and postcourse knowledge (% questions answered correctly) and confidence ratings. Prior implant experience was assessed.Results31 residents participated in this study. The majority of the participants were 4th- (41.9%) and 5th-year residents (38.7%). Participants showed a significant improvement in procedural knowledge test scores (68.8±13.4 vs 74.2 ± 13.0, P < .05) and self-reported increased median surgical confidence levels (4 vs 3, P value < .001) after completion of the cadaveric course. Subgroup analysis demonstrated that residents with prosthetic surgery experience of <10 cases benefited the most. In addition, improvement in surgical confidence levels observed was greater than the improvement in surgical knowledge. The overall cost of the simulation training course was approximately $1,483 per resident.ConclusionSimulation training in prosthetic surgery seems to improve surgical confidence and knowledge. Further research is needed to better understand the benefits and limitations of simulation training.Lentz AC, Rodríguez D, Davis LG. Simulation training in penile implant surgery: Assessment of surgical confidence and knowledge with cadaveric laboratory training. Sex Med 2018;6:332–338.

Cadaveric Penile Prosthesis Workshop training improves surgical confidence levels of urologists: South Asian Society for Sexual Medicine course survey

“…16 Hence, simulation training programs are the need of the hour, and Lentz et al first published the positive outcomes of simulation surgical training for urology residents in PP surgery. The results of the present study reiterate the fact that the cadaveric training in PP improves procedural knowledge test scores and surgical confidence levels, similar to the study published by Lentz et al 13 The present study had no urology residents; instead all were consultant urologists/andrologists. The major challenge that was encountered in the cadaver laboratory was that the tissue planes of some cadavers that were Thiel embalmed were not good for dissection, and hence significant effort had to be put into corporal dilatation.…”

“…Hence giving 2 weeks before the start of the workshop and up to 1 week after the workshop was considered adequate for the participants to complete the survey in the present study. 13 The common concerns raised by the participants in the cadaver laboratory were the placement of the reservoir and the high cost of the three-piece penile PP for the South Asian scenario. High-volume prosthetic urologists prefer to place the reservoir through the same penoscrotal incision.…”

“…A 5-point Likert scale was used to quantify the surgical confidence level (not at all confident, minimally confident, average confidence, above average confidence and very confident). This survey questionnaire was adapted from the previous study by Lentz et al 13 The 10 "observers" were not included in the study. Of the 72 "hands-on" participants, just 45 completed both the preand post-workshop survey.…”

“…The group noted significant improvement in procedural test scores and median surgical confidence levels. 13 The purpose of the present study was to analyze the impact of the cadaver laboratory course on urologists and andrologists predominantly from South Asian countries in learning the three-piece inflatable PP surgery.…”

3D pelvic cadaver model: a novel approach to surgical training for penile implant surgery

“…Last but not least, training and surgical education takes place in centres of excellence under direct supervision of high-volume dedicated surgeons. Once trainees have completed this training module they can become safety certified to offer their patients these types of interventions [1][2][3][4][5][6].…”