Novel Inanimate Training Model for Urethrovesical Anastomosis in Laparoscopic Radical Prostatectomy

Abstract

We developed a novel ex vivo training model for advanced laparoscopic suturing techniques necessary in laparoscopic radical prostatectomy (LRP). An inanimate model was developed to approximate real-life conditions in laparoscopic urethrovesical anastomosis. A segment of porcine ovarian tube inserted through a hard piece of cardboard (urethral stump) in a small open box and a part of pig stomach with a 2-cm hole (bladder neck) were placed in a specially designed setup in a traditional pelvic trainer, while the trocars were arranged in the usual five-port style during an LRP. The trainees practised suturing the "bladder neck" to the "urethral stump" with intermittent or continuous sutures according to their preferences. The setup successfully mimicked the spatial relationships of the organs to be anastomosed during live surgery. The directions of the trocars and the angles of the instrumentations in the training model also imitated those during LRP. After practising on our models, the surgeons spent significantly less time (65 ± 24 min vs. 36 ± 12 min, p = 0.035) performing actual urethrovesical anastomosis. This inanimate laparoscopic suturing training model for urethrovesical anastomosis is a novel, effective, convenient and economic training tool, especially for beginners of LRP.