title: Development, validation and operating room-transfer of a six-step laparoscopic training program for the vesicourethral anastomosis.
abstract: OBJECTIVE
  Development and full validation of a laparoscopic training program for stepwise learning of a reproducible application of a standardized laparoscopic anastomosis technique and integration into the clinical course.
  
  
  METHODS
  The training of vesicourethral anastomosis (VUA) was divided into six simple standardized steps. To fix the objective criteria, four experienced surgeons performed the stepwise training protocol. Thirty-eight participants with no previous laparoscopic experience were investigated in their training performance. The times needed to manage each training step and the total training time were recorded. The integration into the clinical course was investigated. The training results and the corresponding steps during laparoscopic radical prostatectomy (LRP) were analyzed. Data analysis of corresponding operating room (OR) sections of 793 LRP was performed. Based on the validity, criteria were determined.
  
  
  RESULTS
  In the laboratory section, a significant reduction of OR time for every step was seen in all participants. Coordination: 62%; longitudinal incision: 52%; inverted U-shape incision: 43%; plexus: 47%. Anastomosis catheter model: 38%. VUA: 38%. The laboratory section required a total time of 29 hours (minimum: 16 hours; maximum: 42 hours). All participants had shorter execution times in the laboratory than under real conditions. The best match was found within the VUA model. To perform an anastomosis under real conditions, 25% more time was needed. By using the training protocol, the performance of the VUA is comparable to that of an surgeon with experience of about 50 laparoscopic VUA. Data analysis proved content, construct, and prognostic validity.
  
  
  CONCLUSIONS
  The use of stepwise training approaches enables a surgeon to learn and reproduce complex reconstructive surgical tasks: eg, the VUA in a safe environment. The validity of the designed system is given at all levels and should be used as a standard in the clinical surgical training in laparoscopic reconstructive urology.
authors.affiliation: Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany. jan.klein@slk-kliniken.de
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.forename: Tom
authors.initials: T
authors.lastname: Frede
authors.forename: Christian
authors.initials: C
authors.lastname: Stock
authors.forename: Marcel
authors.initials: M
authors.lastname: Hruza
authors.forename: Ali
authors.initials: A
authors.lastname: Gözen
authors.forename: Othmar
authors.initials: O
authors.lastname: Seemann
authors.forename: Michael
authors.initials: M
authors.lastname: Schulze
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education* / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy / Q000193:education*; D009873:Operating Rooms; D010360:Patient Transfer; D011468:Prostatectomy / Q000193:education; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*