A training model for laparoscopic urethrovesical anastomosis.

PURPOSE: To create and evaluate the effectiveness of an in vitro training model for laparoscopic urethrovesical anastomosis.

MATERIALS AND

METHODS

Chicken posterior trunks and porcine colons were used to construct the training model, which was later compared with the chicken skin model. The posterior trunk of a chicken was used to simulate a human pelvis, and a 3-mm cloacal stump was used to simulate a human urethral stump. A 15-cm segment of porcine colon with a 1-cm orifice was used to simulate a human bladder or neobladder. An imitation urethrovesical anastomosis was performed with laparoscopic instruments in a laparoscopic training box. The simulated urethral stump and bladder neck were anastomosed with six interrupted stitches. Forty urologic residents were randomized into two groups. The residents in group A (n = 20) practiced using this model for 8 hours, while those in group B (n = 20) practiced using the chicken skin model for 8 hours. The residents' skills were assessed using the porcine model before and after training.

RESULTS

All residents accomplished the training course and both assessments. There was no significant difference between the groups in anastomosis time (122.65 +/- 19.98 minutes v 120.70 +/- 17.30 minutes, P > 0.05) and quality (3.80 +/- 1.24 v 3.75 +/- 1.16, P > 0.05) before training. After the training sessions, both groups improved in anastomosis time and quality. Compared with residents in group B, residents in group A required less time (63.55 +/- 11.08 minutes v 76.55 +/- 12.46 minutes, P < 0.05) and achieved a higher quality score (8.80 +/- 1.00 v 7.65 +/- 0.88, P < 0.05).

CONCLUSION

This training model more accurately resembles the structure and characteristic of the human pelvis, urethral stump, and bladder (neobladder). In addition, all the materials needed for this model are inexpensive and easily obtained. Therefore, it is an effective, convenient training model for laparoscopic urethrovesical anastomosis.