Realistic Anatomical Prostate Models for Surgical Skills Workshops Using Ballistic Gelatin for Nerve-Sparing Radical Prostatectomy and Fruit for Simple Prostatectomy

Abstract

PurposeUnderstanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function. The objectives of this study were to develop inexpensive and simple but anatomically accurate prostate models not involving human or animal elements to teach the terminology and practical aspects of nerve-sparing RP and simple prostatectomy (SP).Materials and MethodsThe RP model used a Foley catheter with ballistics gelatin in the balloon and mesh fabric (neurovascular bundles) and balloons (prostatic fascial layers) on either side for the practice of inter- and intrafascial techniques. The SP model required only a ripe clementine, for which the skin represented compressed normal prostate, the pulp represented benign tissue, and the pith mimicked fibrous adhesions. A modification with a balloon through the fruit center acted as a "urethra."ResultsBoth models were easily created and successfully represented the principles of anatomical nerve-sparing RP and SP. Both models were tested in workshops by urologists and residents of differing levels with positive feedback.ConclusionsLow-fidelity models for prostate anatomy demonstration and surgical practice are feasible. They are inexpensive and simple to construct. Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP. The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive.

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

“…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.…”

A novel palpation–based method for tumor nodule quantification in soft tissue—computational framework and experimental validation

“…A gelatin phantom which mechanically mimics the prostatic tissue was used to validate the proposed framework. Such material has been widely used for surgical training [25] and ultrasound diagnosis [26] for prostate. To make the phantom materials, gelatin powder was mixed with boiling water (144 g/l for "cancerous" and 120 g/l for 'healthy' samples) and the cancerous sample was dyed Fig.…”

Urology technical and non‐technical skills development: the emerging role of simulation

“…However, it can be difficult to achieve high fidelity simulation creating complex clinical scenarios, while controlling and testing the many possible variables [35]. Despite this challenge, inexpensive, relatively high fidelity technical models have been developed for pyeloplasty and radical prostatectomy [36,37]. Similarly, Brewin et al [33] demonstrated that full immersion simulation via distributed simulation environment using a portable inflatable 360°e nclosure, facilitated technical and non-technical learning in a relatively cost-effective manner.…”

“…3 Building simulation modules around the three fundamental categories of open, laparoscopic/robotic and endoscopic surgery. 4 Looking for reusable or inexpensive items to build models such as those described for pyeloplasty and radical prostatectomy [36,37]. 5 Utilising resources that are not obvious such as butcher shops and industrial shops for thrown away materials, cheap tooling or machining needs.…”