Simulated training model of ureteropyelic anastomosis in laparoscopic pyeloplasty

Abstract Purpose: To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty. Methods: Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model. Results: In the evaluation of all participants' suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011). Conclusion: We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants' opinion and its validation by expert surgeons.

Simulated training of a laparoscopic vesicourethral anastomosis

Abstract Purpose: To develop a model and curriculum for simulated training of an effective and well accepted laparoscopic vesicourethral anastomosis (VUA). Methods: Experimental longitudinal study of quantitative character. The sample consisted of 12 general surgery residents and 6 urology residents (R3). The training consisted of making twelve VUAs on synthetic organs. The training was divided into four sessions and accompanied by an instructor who performed positive feedback. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The best-rated items were the facilitator positive feedback and the fact that the training was carried out at the teaching hospital premises. Conclusions: The proposed training model was well accepted and proved to be effective in reducing operative time and improving laparoscopic skills. The training should be fractionated (4 sessions in 3 weeks), repetitive (12 anastomoses) and have positive feedback.