title: Development and initial assessment of a training program for laparoscopic radical prostatectomy. First module: the urethrovesical anastomosis.
abstract: OBJECTIVE
  We present our experience in the design and development of a training program in laparoscopic radical prostatectomy (LRP), and the validation of the first steps of the program by objective measurement of the attendants' skills improvement and subjective evaluation of its contents.
  
  
  METHODS
  Our training model on LRP has a total duration of 42 hours, divided in two modules of 21 hours each, performed 1 month apart. Data included in the present study were obtained from the first module of our course. It begins with acquisition of basic knowledge in ergonomics and instrument concepts, after which the attendants develop essential laparoscopic dexterities through the performance of hands-on physical simulator tasks. During the second and third day, urologists performed urethrovesical anastomosis also in the physical simulator. Attendants' skills improvement was measured during the first module by registering surgical times and suturing quality of the anastomosis, the latter by means of a leak test. At the end of the training program, a subjective evaluation questionnaire on the different didactic and organizational aspects was handed out to the attendants.
  
  
  RESULTS
  By comparing first and last anastomosis, we observed a significant decrease in surgical times (minutes) (T1 40.1±4.6 vs T6 24.01±3.34; P≤0.005) and an increase in intraluminal leak pressure (mm Hg) (T1 8.27±7.33 vs T6 21.09±6.72; P≤0.005). We obtained a highly positive score on all questions concerning the different topics and techniques included in the training program (≥9 points over 10). Regarding the attendants' self-assessment of acquired abilities, 78.3% considered themselves capacitated to perform the trained procedures on patients.
  
  
  CONCLUSIONS
  Training obtained during the first module of our training model significantly decreased performance times for ex vivo urethrovesical anastomosis, simultaneously increasing its quality. In addition, validation of the training model was also demonstrated by the highly scored evaluation resulting from the attendants' assessment.
authors.affiliation: 1 Laparoscopy Unit, Jesús Usón Minimally Invasive Surgery Centre , Cáceres, Spain .
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Pérez-Duarte
authors.forename: Blanca
authors.initials: B
authors.lastname: Fernández-Tomé
authors.forename: Idola
authors.initials: I
authors.lastname: Díaz-Güemes
authors.forename: Silvia
authors.initials: S
authors.lastname: Enciso
authors.forename: Ana M
authors.initials: AM
authors.lastname: Matos-Azevedo
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sánchez-Hurtado
authors.forename: Laura
authors.initials: L
authors.lastname: Hernández
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Sánchez-Margallo
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak; D006804:Ergonomics; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008297:Male; D061646:Operative Time; D016730:Program Development; D015397:Program Evaluation; D011468:Prostatectomy / Q000193:education* / Q000379:methods; D011795:Surveys and Questionnaires; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014572:Urology / Q000193:education