title: A new training model for robot-assisted urethrovesical anastomosis and posterior muscle-fascial reconstruction: the Verona training technique.
abstract: A training model is usually needed to teach robotic surgical technique successfully. In this way, an ideal training model should mimic as much as possible the "in vivo" procedure and allow several consecutive surgical simulations. The goal of this study was to create a "wet lab" model suitable for RARP training programs, providing the simulation of the posterior fascial reconstruction. The second aim was to compare the original "Venezuelan" chicken model described by Sotelo to our training model. Our training model consists of performing an anastomosis, reproducing the surgical procedure in "vivo" as in RARP, between proventriculus and the proximal portion of the esophagus. A posterior fascial reconstruction simulating Rocco's stitch is performed between the tissues located under the posterior surface of the esophagus and the tissue represented by the serosa of the proventriculus. From 2014 to 2015, during 6 different full-immersion training courses, thirty-four surgeons performed the urethrovesical anastomosis using our model and the Sotelo's one. After the training period, each surgeon was asked to fill out a non-validated questionnaire to perform an evaluation of the differences between the two training models. Our model was judged the best model, in terms of similarity with urethral tissue and similarity with the anatomic unit urethra-pelvic wall. Our training model as reported by all trainees is easily reproducible and anatomically comparable with the urethrovesical anastomosis as performed during radical prostatectomy in humans. It is suitable for performing posterior fascial reconstruction reported by Rocco. In this context, our surgical training model could be routinely proposed in all robotic training courses to develop specific expertise in urethrovesical anastomosis with the reproducibility of the Rocco stitch.
authors.affiliation: Department of Urology, University of Verona, Verona, Italy. giovanni.cacciamani@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Cacciamani
authors.affiliation: Department of Urology, University of Verona, Verona, Italy.
authors.forename: V
authors.initials: V
authors.lastname: De Marco
authors.affiliation: Department of Urology, University of Verona, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Siracusano
authors.affiliation: Department of Urology, University of Verona, Verona, Italy.
authors.forename: D
authors.initials: D
authors.lastname: De Marchi
authors.affiliation: Department of Urology, University of Verona, Verona, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bizzotto
authors.affiliation: Department of Urology, University of Verona, Verona, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Cerruto
authors.affiliation: Si.F.A.R.V. Centro di Simulazione e Formazione Avanzata della Regione Veneto, Verona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Motton
authors.affiliation: Department of Urology, University of Verona, Verona, Italy.
authors.forename: A B
authors.initials: AB
authors.lastname: Porcaro
authors.affiliation: Department of Urology, University of Verona, Verona, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education / Q000379:methods; D000818:Animals; D002645:Chickens; D004195:Disease Models, Animal; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017145:Models, Educational; D011468:Prostatectomy / Q000193:education* / Q000379:methods; D019651:Plastic Surgery Procedures / Q000193:education* / Q000379:methods; D065287:Robotic Surgical Procedures / Q000193:education* / Q000379:methods; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*
keywords: Prostate cancer; Robot-assisted radical prostatectomy; Robotic surgery; Robotic training; Technical skills; Urethrovesical anastomosis; Wet lab