Simulated training model of ureteropyelic anastomosis in laparoscopic pyeloplasty.

Juliana Cynara Santos Lima,Rômulo Augusto Da Silveira,David Augusto Batista Sá Araújo,Gleydson Cesar Borges,Francisco José Cabral Mesquita,Hermano Alexandre Lima Rocha

doi:10.1590/acb351108

Juliana Cynara Santos Lima, Rômulo Augusto Da Silveira + Show 4 more

Open Access

https://doi.org/10.1590/acb351108

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Abstract

Purpose:To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty.Methods:Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model.Results:In the evaluation of all participants’ suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011).Conclusion:We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants’ opinion and its validation by expert surgeons.

Highlights

Urological congenital malformations, in most cases, present as hydronephrosis, being the main cause of ureteropelvic junction (UPJ) obstruction, which is the narrowing of the ureter in its proximal part, near the renal pelvis, and can cause reduction or paralysis of urinary flow through the ureter and develop into loss of renal function
Regarding the evaluation of the participants’ experience in laparoscopic surgery and ureteropyelic anastomosis, the surgery that was most often previously performed by the participants was laparoscopic cholecystectomy, with 100% of the participants, and the surgery with the fewest number of participants with experience was laparoscopy fundoplication, with only 12.5%
During the preparation of the first anastomosis, it was verified that the students showed a great variation regarding time of performance, ranging between 13.71 to 25.98 min to perform an ureteropyelic anastomosis by laparoscopy, which was similar to that performed by the experts, ranging from 3.71 to 25.98 min, showing that there were different levels of skills

Summary

Introduction

Urological congenital malformations, in most cases, present as hydronephrosis, being the main cause of ureteropelvic junction (UPJ) obstruction, which is the narrowing of the ureter in its proximal part, near the renal pelvis, and can cause reduction or paralysis of urinary flow through the ureter and develop into loss of renal function. Surgery is indicated when there is significant hydronephrosis associated with loss of renal function higher than 40%. Laparoscopic surgery is recommended after 2 years of age[1]. Surgery may be open (dismembered or with pelvic flaps), endoscopic, laparoscopic or robotic, and is indicated for symptomatic or asymptomatic patients with renal function loss or increased anteroposterior diameter of the renal pelvis or hydronephrosis grades III and IV2

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