Simple Model for Training in the Laparoscopic Vesicourethral Running Anastomosis

Abstract

This simple model allows the trainee in laparoscopic urology to acquire the skills necessary to perform a laparoscopic vesicourethral anastomosis, one of the most complex steps in laparoscopic radical prostatectomy, as well as to develop dexterity and facility in laparoscopic manipulation of needles, sutures, and fragile tissues.

Task-specific bench model training versus basic laparoscopic skills training for laparoscopic radical prostatectomy: a randomized controlled study

“…After performing 20 anastomoses on this model, 2 urology fellows reduced the time required for performing the anastomosis from 75 to 20 minutes Task-specific bench model training v. basic laparoscopic skills training and were able to create a watertight running LUA in patients in a mean time of 40 minutes (range 30-55 min). 8 In our study, participants who trained on the UVM performed the urethrovesical anastomosis in a mean time of 27.6 minutes, approaching performance in the study by Nadu and colleagues. 8 Other training models studied include human cadavers, live animals and virtual reality (VR) simulators to teach surgical skills.…”

“…8 In our study, participants who trained on the UVM performed the urethrovesical anastomosis in a mean time of 27.6 minutes, approaching performance in the study by Nadu and colleagues. 8 Other training models studied include human cadavers, live animals and virtual reality (VR) simulators to teach surgical skills. Human cadavers most closely resemble live patients but they are expensive, have limited availability, have stiffer tissues and may transmit infections.…”

“…By using this model and dividing complicated surgical steps into simplified tasks (e.g., passage of ligature, intracorporal knotting, intracorporeal suturing, linear anastomosis, circular running suture anastomosis with chicken skin), they were able to substantially improve trainee performance. Nadu and colleagues 8 developed a simple model using chicken skin in a pelvic trainer. After performing 20 anastomoses on this model, 2 urology fellows reduced the time required for performing the anastomosis from 75 to 20 minutes Task-specific bench model training v. basic laparoscopic skills training and were able to create a watertight running LUA in patients in a mean time of 40 minutes (range 30-55 min).…”

Methods of training using pelvic trainers

“…An example for such a task is the performance of a laparoscopic urethrovesical anastomosis following radical prostatectomy. To better practice this step in the lab, Nadu et al [31] developed a simple model made from chicken skin. The model consisted of a urethra, prepared by tabularizing a 5-x 4-cm piece of skin over a 14-F silicon catheter and suturing the edges, and a bladder neck, designed from a 8-x 8-cm piece of skin.…”

Comparison of Running and Interrupted Vesicourethral Anastomoses in a Porcine Model

“…1,5 However, others have described application of a continuous anastomosis (CA). [6][7][8][9] Previous authors in other surgical specialties have focused on the issue of IA versus CA for tracheal, 10 esophageal, 11 fallopian tube, 12 intestinal, [13][14][15] and vascular [16][17][18][19][20][21] anastomoses. None of these studies has established the superiority of one technique, making the individual surgeon's preference paramount.…”