Current status of wet lab and cadaveric simulation in urological training: A systematic review

MANGOU (Miyazaki Advanced New General Surgery of University) Wet Lab Training Relieves Anxiety About Surgical Skills in Surgical Education: A Cross-Sectional Study

PURPOSE

To increase the number of medical students or residents who want to become surgeons, we must evaluate our program that recruits new young surgeons.

METHODS

We planned surgical training programs for medical students and residents that we named the MANGOU (Miyazaki Advanced New General surgery Of University) training project in the Department of Surgery, Miyazaki University, Japan. From January 2016 through December 2022, we asked trainees who attended this training to complete questionnaires to evaluate their interest in surgery, confidence in surgical skills, and training. Scoring of the questionnaire responses was based on a 5-point Likert scale, and we evaluated this training prospectively.

RESULTS

Among the 109 trainees participating in this training, 61 answered the questionnaires. Two participants found the training boring, but 59 (96.7%) enjoyed it. All of them answered "Yes" to wanting to participate in the next training. Respective pre- and post-training scores were as follows: confidence in surgical skills, 2.2 ± 1.0 and 3.0 ± 1.0 (p < 0.0001); interest in surgery, 4.2 ± 0.8 and 4.4 ± 0.5 (p = 0.0011); and willingness to become surgeons, 3.9 ± 0.7 and 4.1 ± 0.6 (p = 0.0011). All scores rose after MANGOU training.

CONCLUSION

We planned MANGOU surgical wet lab training for medical students and residents that aimed to educate and recruit new surgeons. After joining the MANGOU training, the trainees' anxiety about surgery was reduced, their confidence in performing surgical procedures improved, they showed more interest in surgery, and they increased their motivation to become surgeons.

Use of Thiel-embalmed cadavers in urology training and their ability to retain real-life anatomy: a systematic review

BACKGROUND

Thiel-embalmed cadavers (TeCs) have been proposed as an alternative and probably safer method of surgical training, compared to formalin-embalmed cadavers. We aimed to perform a systematic review on the use of TeCs in urology training and their ability to represent real-life anatomy.

METHODS

PubMed, SCOPUS and Cochrane databases were searched for articles with purpose to explore the use of TeCs in urology training, without date restrictions, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From each paper, we evaluated the type of procedure, the number of participants, the type of study, the educational outcomes and their level, according to Kirkpatrick hierarchy.

RESULTS

Of the 225 records initially retrieved, eight articles were eventually included. All studies evaluated participants' perceptions about the procedure. Overall, urology trainees and specialists have positively commented on the educational value of TeCs, which have been also found able to adequately mimic real-life conditions. In all the eight studies, trainees stated that tissue quality of TeCs was adequately realistic and considered TeCs as a useful surgical training tool.

CONCLUSION

Although the use of TeCs in urology training has so far been limited, their value as a surgical training tool has been positively perceived. These outcomes suggest that TeCs may also enhance urology trainees' surgical skills and may encourage their implementation as a simulation tool in urology training.

Automating Endoscope Motion in Robotic Surgery: A Usability Study on da Vinci-Assisted Ex Vivo Neobladder Reconstruction

Robots for minimally invasive surgery introduce many advantages, but still require the surgeon to alternatively control the surgical instruments and the endoscope. This work aims at providing autonomous navigation of the endoscope during a surgical procedure. The autonomous endoscope motion was based on kinematic tracking of the surgical instruments and integrated with the da Vinci Research Kit. A preclinical usability study was conducted by 10 urologists. They carried out an ex vivo orthotopic neobladder reconstruction twice, using both traditional and autonomous endoscope control. The usability of the system was tested by asking participants to fill standard system usability scales. Moreover, the effectiveness of the method was assessed by analyzing the total procedure time and the time spent with the instruments out of the field of view. The average system usability score overcame the threshold usually identified as the limit to assess good usability (average score = 73.25 > 68). The average total procedure time with the autonomous endoscope navigation was comparable with the classic control (p = 0.85 > 0.05), yet it significantly reduced the time out of the field of view (p = 0.022 < 0.05). Based on our findings, the autonomous endoscope improves the usability of the surgical system, and it has the potential to be an additional and customizable tool for the surgeon that can always take control of the endoscope or leave it to move autonomously.

The SIMULATE ureteroscopy training curriculum: educational value and transfer of skills

Objective

Different simulation modalities may be utilised in a curricular fashion to benefit from the strengths of each training model. The aim of this study is to evaluate a novel multi-modality ureterorenoscopy (URS) simulation curriculum in terms of educational value, content validity, transfer of skills and inter-rater reliability.

Methods

This international prospective study recruited urology residents (n = 46) with ≤ 10 URS experience and no prior simulation training. Participants were guided through each phase of the expert-developed SIMULATE URS curriculum by trainers and followed-up in the operating room (OR). Video recordings were obtained during training. A post-training evaluation survey was distributed to evaluate content validity and educational value, using descriptive statistics. Performance was evaluated using the objective structured assessment of technical skills (OSATS) scale to measure improvement in scores throughout the curriculum. Pearson’s correlation coefficient and Cohen’s kappa tests were utilised to investigate correlation and agreement between raters.

Results

Participants reported gaining OR-transferrable skills (Mean: 4.33 ± 0.67) and demonstrated marked improvement in throughout the curriculum, transferred to the OR for both semi-rigid URS (p = 0.004) and flexible URS (p = 0.007). 70% of participants were successfully followed-up in the OR (n = 32). No differences were identified with the additional use of fresh frozen cadavers (p = 0.85, p = 0.90) and the URO Mentor VR simulator (p = 0.13, p = 0.22). A moderate level of correlation was noted on the video OSATS assessments, between two expert assessors (r = 0.70), but a poor agreement with the live rating.

Conclusion

The SIMULATE URS training curriculum received high educational value from participants, who demonstrated statistically significant improvement with consecutive cases throughout the curriculum and transferability of skills to the OR in both semi-rigid and flexible URS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-021-03604-w.