title: Laparoscopic ileocystoplasty: an experimental study in pigs.
abstract: OBJECTIVE
  Bladder dysfunction may lead to urinary incontinence and progressive kidney deterioration. When clinical treatment fails, bladder augmentation is the operation of choice in most cases. The purpose of this study was the standardization of the technique of videolaparoscopic ileocystoplasty in a porcine model and demonstration of a tutor-supervised learning curve.
  
  
  METHODS
  The study was conducted on 15 Large-White male pigs (20-25 kg) that underwent ileocystoplasty with 15 cm of distal ileum shaped into a using extracorporeal technique and laparoscopic ileovesical anastomosis. Operative time, ileovesical anastomosis time, intraoperative complications, and extravasation after anastomosis were evaluated. To assess the learning curve, the animals were divided into three groups of five: group I (operated on in collaboration with a tutor), group II (treated under the supervision of tutor), and group III (without the tutor's collaboration or supervision).
  
  
  RESULTS
  Total surgical time and ileovesical anastomosis time revealed significant differences (P < 0.05) between groups I and III (70% reduction) as well as between groups II and III (64% reduction).
  
  
  CONCLUSIONS
  Laparoscopic ileocystoplasty in pigs is feasible without special laparoscopic material. Ten initial procedures with a tutor's help were important for technique acquisition and mastery. A sharp increase in efficiency occurs between the tenth and fifteenth procedures. These procedures should be executed at least ten times in the presence of the tutor to enable the surgeon to overcome the learning curve.
authors.affiliation: Urology Institute of Piracicaba (IUP), Piracicaba, SP, Brazil. nlavoura@terra.com.br
authors.forename: Nivaldo
authors.initials: N
authors.lastname: Lavoura
authors.forename: Carlos Arturo Levi
authors.initials: CA
authors.lastname: D'Ancona
authors.forename: Gustavo Mendonça
authors.initials: GM
authors.lastname: Borges
authors.forename: Nelson Rodrigues
authors.initials: NR
authors.lastname: Netto
authors.forename: Francisco Castro
authors.initials: FC
authors.lastname: Neves
authors.forename: Daniel
authors.initials: D
authors.lastname: da Silva
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D013525:Surgical Instruments; D013552:Swine; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery