Cost-Effective and Readily Replicable Surgical Simulation Model Improves Trainee Performance in Benchtop Robotic Urethrovesical Anastomosis

Abstract

INTRODUCTION: Our objective was to develop a simple, cost-effective and reusable model for urethrovesical anastomosis for robotic-assisted radical prostatectomy and evaluate its impact on fundamental surgical skills and confidence of urology trainees. METHODS: A model for the bladder, urethra and bony pelvis was created from materials easily purchased online. Each participant performed several trials of urethrovesical anastomosis using the da Vinci Si® surgical system. Pre-task confidence was assessed prior to each attempt. Two blinded researchers measured the following outcomes: time-to-anastomosis, number of suture throws, perpendicular needle entry and atraumatic needle driving. Integrity of the anastomosis was estimated by gravity filling and measuring pressure at which leakage occurred. These outcomes were translated into an independently validated Prostatectomy Assessment Competency Evaluation score. RESULTS: The model took 2 hours to create and total cost was 64 U.S. dollars. Twenty-one residents enrolled and demonstrated significant improvement in time-to-anastomosis, perpendicular needle driving, anastomotic pressure and total Prostatectomy Assessment Competency Evaluation score between the first and third trial. Pre-task confidence was measured on a Likert scale (1-5) and improved significantly over the 3 trials (Likert scale of 1.8, 2.8 and 3.3). CONCLUSIONS: We developed a cost-effective model of urethrovesical anastomosis that does not require the use of a 3D printer. This study demonstrates significant improvement of fundamental surgical skills and validated surgical assessment score for urology trainees over several trials. Our model shows potential for increasing accessibility of robotic training models for urological education. Additional investigation will be required to further assess the utility and validity of this model.