A simplified 5-step model for training laparoscopic urethrovesical anastomosis.
OBJECTIVE
We developed a training model and program aimed at improving the skills of urologists with no previous experience in laparoscopy to perform a running suture urethrovesical anastomosis as is done during laparoscopic radical prostatectomy.


METHODS
Our program is performed on a pelvic trainer with a videolaparoscopic unit and consists of passage of a ligature, intracorporal knotting, intracorporal suturing, linear anastomosis and circular running suture anastomosis. The trainees performed the first 3 tasks during the initial lessons and then advanced to the 2 final tasks. At the end of each lesson time was recorded and progression curve was plotted for each participant for each task. The end point of the study was participant ability to perform an accurate circular anastomosis. Logarithmic regression analysis was used to assess the significance of progression.


RESULTS
All 10 urologists who participated in this study showed a rapid and significant decrease in the time required to perform the first 3 tasks accurately. The participants were able to perform a linear anastomosis after 3 to 5 lessons and an accurate circular anastomosis after 5 to 10 lessons.


CONCLUSIONS
By using this model and dividing a complicated surgical step to simplified tasks, we were able to improve trainee performance significantly in a short time. A training program for basic and advanced laparoscopic skills should be incorporated into the syllabus of urologists-in-training and available to those who wish to gain experience in laparoscopic surgery.
Katz
Ran
R
Department of Urology, CHU Henri Mondor, Creteil, France.
Nadu
Andrei
A
Olsson
Leif E
LE
Hoznek
Andras
A
de la Taille
Alexandre
A
Salomon
Laurent
L
Abbou
Clement-Claude
CC
D000714:Anastomosis, Surgical / Q000193:education; D004502:Education, Medical, Continuing; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008953:Models, Anatomic; D013536:Suture Techniques / Q000193:education; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000193:education* / Q000379:methods; D014572:Urology / Q000193:education*