The novel laparoscopic training 3D model in urology with surgical anatomic remarks: Fresh-frozen cadaveric tissue

Organ harvesting as a mandatory training step of all PGY1 and PGY2 surgical residents

To the Editor, Good surgical training is essential for the formation of excellent surgeons, consequently providing the best possible care for our patients in the future. Considering the increase in surgeon shortage over the last two decades (estimated between 14,300 and 23,400 by the year 2032 only in the US), it is important for filling the national health system's needs as well [...].

A new technique for preparing cadavers using PMMA: Rat and mouse example

BACKGROUND

Polymethyl methacrylate is a member of the acrylic polymer family with superior optical properties. It is used in dentistry, hospital incubators, lenses, and various surgical fields, especially orthopedics. In this preliminary study, we aimed to prepare cadavers using the industrial form of polymethyl methacrylate.

METHODS

The new technique consists of fixation, washing, purification, impregnation, and polymerization. For the study, two whole rat bodies, two rat front legs and two rat hind legs, one half rat body, two whole mouse bodies, and all internal organs were used. Wistar albino rats and BALB/c mice were used. After the cadaver samples were fixed and washed, they were passed through an alcohol series starting from 50%, completing the purification process. In the next step, a solution was prepared by mixing 100 ml of Thinner into 1000 ml of a mixture containing styrene, methyl methacrylate, and Co(II)2-ethyl hexanoate. The samples were immersed in the solution under negative pressure (from 10 mmHg to 400 mmHg), allowing the samples to absorb the solution thoroughly. They were then treated with methyl ethyl ketone peroxide and the polymerization step was terminated.

RESULTS

The cadaver samples obtained using polymer were hard, they maintained the given shape, and showed a relatively transparent quality. The production of these materials took 35 days, excluding fixation. The tissue samples were odorless in the process after polymerization. Also, there was no decay in the samples after the production stage and they could be stored under room conditions.

CONCLUSION

This study determined that cadavers could be prepared using polymethyl methacrylate and methyl ethyl ketone peroxide. The polymer used here cost about $5. The cadavers can be safely exhibited in room conditions for five years without requiring special conditions like pools or cold storage. Further research should compare this technique with the plastination technique in terms of texture, color, weight, application time, and cost.

Validation of a new artificial model for simulated training of a laparoscopic vesicourethral anastomosis

OBJECTIVE

The aim of this study is to prove the effectiveness of a low cost, artificial model for training of a laparoscopic urethrovesical anastomosis.

MATERIALS AND METHODS

This study included urologists who attended specialised courses on laparoscopic radical prostatectomy (LRP) held during the period 2015 to 2017. They were divided into 2 groups according to their previous experience in laparoscopic surgery. The tasks performed on the artificial simulator were prostate resection, "task 1", and urethrovesical anastomosis, "task 2". Once these exercises were completed, the study participants filled in an anonymous questionnaire regarding their demographic data and experience level in laparoscopic surgery (LS). In addition, they gave their opinions about the didactic capacity of the artificial organ and evaluated its usefulness as a tool for LRP training. To demonstrate face and content validity, the participants judged the texture, consistency, morphology and evaluated its similarity to the real organ. The assessment was made with a five-point Likert scale.

RESULTS

The students were divided into 2groups: 10 experts (Group E) and 12 novices (Group N). The only significant difference between the scores of novices and experts was regarding the inclusion of this tool in the training programs (Group E=5 points versus group N=4.4±0.59, P=.024). The experts' group rated all the items with higher scores than the novices' one. Regarding the general assessment of the simulation model, the novice participants gave an average score of 8.00±0.91 points out of 10, while the experts' group granted higher scores of 9.4±0,51.

CONCLUSION

This artificial model has shown to have an elevated face, content and construct validity, as well being an optimal didactic tool for training in the techniques of prostate resection and laparoscopic urethrovesical anastomosis.

Cost, training and simulation models for robotic-assisted surgery in pediatric urology

INTRODUCTION

Laparoscopic procedures in pediatric urology have been shown to be safe and effective over the last number of years. Coupled with this is the technological trend to provide minimally invasive options for even the most complex pediatric patients. Whilst robotic platforms continue to try to demonstrate superior patient outcomes in adults with mixed results, the utilization of robotic platforms for pediatric urology is increasing.

METHODS

A review of the current literature was undertaken to assess the evidence for training models and cost-effectiveness of robotic-assisted pediatric urology.

CONCLUSIONS

A growing body of evidence in this field has demonstrated that robotic platforms are safe and effective in children and can provide additional reconstructive benefits due to motion scaling, magnification, stereoscopic views, instrument dexterity and tremor reduction. The main drawbacks remain the financial implications associated with this platform through purchase, maintenance, and disposable costs. This review addresses some of the addresses issues pertaining to cost, training and simulation for robotic-assisted surgery in pediatric urology.

Animal ethics in laparoscopic urology training

Laparoscopic urologic operating techniques are in widespread use throughout the world and because of various advantages, over the years they have virtually become a gold standard surgical intervention method. As laparoscopy is a painstaking technique to learn, the training consists of different stages. Within these stages of training, wet laboratory training where animals are used, is the most sensitive stage. The widespread use of experimental animals in medical research necessitated standardization and the establishment of certain regulations. This standardization and organization of laws and regulations started to be discussed in Europe approximately a century ago and have been established on a certain foundation. In this rewiev article, we discuss some important points and ethic rules about laparoscopic urologic training practiced on live animals.

Laparoscopic transperitoneal and retroperitoneal simple nephrectomy: The impact of etiological factors of the results of surgical treatment

OBJECTIVE

This retrospective study compares the perioperative outcomes of laparoscopic simple nephrectomy (LSN) in patients with urinary stone disease (USD) in comparison with LSNs performed for other etiological factors.

MATERIAL AND METHODS

115 LSNs were identified from the two teaching hospitals' database. Depending on the etiological factors, patients were stratified in 2 groups. Group 1 consisted of 63 (mean age 44.8±1.7 [21-71] years) patients; where the cause of non-functioning kidney was USD. Meanwhile, Group 2 included 52 (mean age was 43.6±2.0 [19-78] years) patients; who underwent LSN because of other benign diseases. In both groups, a standardized transabdominal or retroperitoneal approach was used according to the discretion of the attending surgeon. Two groups were compared statistically in terms of perioperative parameters and standardized surgical complications.

RESULTS

The use of transperitoneal approach was higher in Group 1 (69.8% vs. 30.2%) compared to Group 2 (51.9% vs. 48.1%). Elective open conversion was needed in 3 and 2 patients in Groups 1 and 2, respectively. The results for mean operative time (108.9±4.0 min vs. 106.7±5.0), estimated blood loss (92.5±8.2 vs. 86.8±10.1 mL) and length of hospital stay (4.1±0.33 vs. 3.85±0.42 days) were similar between the groups. Despite intraoperative complications were similar between the groups, overall post-operative complications were significantly higher (17.5% vs. 3.8%) in Group 1. However, the rate of significant complications (Clavien 3-5) was similar between the groups.

CONCLUSION

The present study revealed that perioperative outcomes of patients undergoing LSN for USD are similar to those seen in patients undergoing LSN for other etiological factors.

Training in Robotic Surgery-an Overview

PURPOSE OF REVIEW

There has been a rapid and widespread adoption of the robotic surgical system with a lag in the development of a comprehensive training and credentialing framework. A literature search on robotic surgical training techniques and benchmarks was conducted to provide an evidence-based road map for the development of a robotic surgical skills for the novice robotic surgeon.

RECENT FINDINGS

A structured training curriculum is suggested incorporating evidence-based training techniques and benchmarks for progress. This usually involves sequential progression from observation, case assisting, acquisition of basic robotic skills in the dry and wet lab setting along with achievement of individual and team-based non-technical skills, modular console training under supervision, and finally independent practice. Robotic surgical training must be based on demonstration of proficiency and safety in executing basic robotic skills and procedural tasks prior to independent practice.