Korean J Urol.  2006 Apr;47(4):407-411. 10.4111/kju.2006.47.4.407.

A Model and a Program for Training Laparoscopic Urethrovesical Anastomosis

• Ahn KI
• Bae KS
• Lee JW
• Park JM
• Lee DK
• Jeon SH

• KMID: 1997152
• DOI: http://doi.org/10.4111/kju.2006.47.4.407

Abstract

PURPOSE
A model and a program was developed for training surgeons in laparoscopic urethrovesical anastomosis in order to improve the laparoscopic suture technique for urologists with no previous experience.
MATERIALS AND METHODS
The procedures were performed on a pelvic trainer using a videolaparoscopic unit. The program consisted of a simple suture, urethrovesical anastomosis with interrupted sutures, and urethrovesical anastomosis with continuous sutures. The trainees enrolled in this study were 5 residents from the urologic department who had little experiences in laparoscopic suturing. The trainees performed each procedure 10 times and the elapsed time was recorded. Univariate analysis of the general linear model was used to assess the significance of progression.
RESULTS
In the first lesson of the simple suture, the mean elapsed time was 5.45+/-3.00 minutes (range 2.78-9.83minutes) and each trainee demonstrated a difference in the elapsed time for suturing. After the tenth lesson was complete, the mean elapsed time was 1.48+/-0.17 minutes (range 1.35- 1.70 minutes) and the time differences between each trainee decreased. In urethrovesical anastomosis with interrupted sutures, the mean elapsed time decreased from 24.07+/-3.97 minutes at the 1st lesson (range 16.13- 29.47 minutes) to 13.10+/-2.53 minutes (range 11.75-19.47 minutes) after 10 lessons. In urethrovesical anastomosis with continuous sutures, the mean time decreased from 39.61+/-3.60 minutes (range 34.41-45.71 minutes) after one lesson to 30.42+/-5.75 minutes (range 19.50-38.82 minutes) after 10 lessons. There were significant differences in the elapsed time up to the 2nd lesson compared with the 10th lesson in all procedures (p-value<0.05). CONCLUSIONS: The skills of the trainee can be improved by a model and a program for training laparoscopic urethrovesical anastomosis. In particular, urethrovesical anastomosis, in which many urologists find difficulty, may become more accessible using this model and program.

Keyword

Laparoscopy; Surgical anastomosis; Training

MeSH Terms

Anastomosis, Surgical
Laparoscopy
Linear Models
Suture Techniques
Sutures

Figure

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  Fig. 1 (A) Vesicourethral anastomosis model. The urethra is made by folding and suturing chicken skin. The bladder is made from larger piece of chicken skin with a hole in middle for the bladder neck. (B) Pelvic trainer with videolaparoscopic unit.

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  Fig. 2 Progression curve of each trainee in a simple suture (A), interrupted anastomosis (B), continuous anastomosis (C).

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  Fig. 3 Progression curve of the average time for all trainees required to perform a simple suture (A), interrupted anastomosis (B), continuous anastomosis (C). *: univariate analysis of general linear model, statistically significant (p<0.05).

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