New Model for Training in Laparoscopic Dismembered Ureteropyeloplasty

Abstract

To create an animal model for teaching laparoscopic dismembered pyeloplasty in which a realistic anatomic environment and the technical points of the procedure could be duplicated. Ten pigs underwent general anesthesia, and the ureter was dissected and spatulated. The small intestine near the renal hilum was trimmed to replace the enlarged renal pelvis, and the "ureteropelvic" anastomosis was performed according to the standard operation steps. A double-pigtail stent was placed in the ureter in antegrade fashion. This model was used by trainees during their year of fellowship in advanced laparoscopic urology. A mentor-trainee fellowship program was planned to guarantee the success of the operations and the quality of the anastomoses. The learning curve was analyzed in terms of the time necessary to perform the task. This model reproduced the technical complexity of laparoscopic dismembered pyeloplasty. The total operating time declined from 135 +/- 14.6 minutes (range 121-155 minutes) to 62 +/- 5.2 minutes (range 56-70 minutes) after the trainees had performed 12 pyeloplasties. The time needed for intraoperative antegrade stenting declined from 35 +/- 12 minutes to 8 +/- 2 minutes. Six pyeloplasties could be performed in every pig with adequate substitutes for an enlarged renal pelvis. With this training, all participants were able to perform ureteropelvic anastomosis and intraoperative antegrade stenting skillfully. This model not only allows trainees to acquire the skills necessary for laparoscopic dismembered pyeloplasty but also provides more practices with the use of a suitable renal pelvic substitute.