Korean J Urol.  2011 Feb;52(2):130-135.

Realistic Anatomical Prostate Models for Surgical Skills Workshops Using Ballistic Gelatin for Nerve-Sparing Radical Prostatectomy and Fruit for Simple Prostatectomy

• Lawrentschuk N
• Lindner U
• Klotz L

Abstract

PURPOSE
Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function. The objectives of this study were to develop inexpensive and simple but anatomically accurate prostate models not involving human or animal elements to teach the terminology and practical aspects of nerve-sparing RP and simple prostatectomy (SP).
MATERIALS AND METHODS
The RP model used a Foley catheter with ballistics gelatin in the balloon and mesh fabric (neurovascular bundles) and balloons (prostatic fascial layers) on either side for the practice of inter- and intrafascial techniques. The SP model required only a ripe clementine, for which the skin represented compressed normal prostate, the pulp represented benign tissue, and the pith mimicked fibrous adhesions. A modification with a balloon through the fruit center acted as a "urethra."
RESULTS
Both models were easily created and successfully represented the principles of anatomical nerve-sparing RP and SP. Both models were tested in workshops by urologists and residents of differing levels with positive feedback.
CONCLUSIONS
Low-fidelity models for prostate anatomy demonstration and surgical practice are feasible. They are inexpensive and simple to construct. Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP. The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive.

Keyword

Anatomic models; Autonomic pathways; Education; Fascia; Prostatectomy

MeSH Terms

Animal Experimentation
Animals
Autonomic Pathways
Catheters
Fascia
Forensic Ballistics
Fruit
Gelatin
Humans
Models, Anatomic
Prostate
Prostatectomy
Skin
Tissue Donors
Gelatin

Figure

• 

  FIG. 1 Ballistics gel radical prostatectomy neurovascular bundle dissection model. The model is complete and fixed to the wood (A). The diagram (B) demonstrates the layers of the prostate, its capsule, the fascias, and the neurovascular bundle. The results of the two techniques are demonstrated (C) with the interfascial dissection still having fascia (blue balloon indicated by yellow arrow) over the capsule yet the neurovascular bundle being pushed away. The intrafascial dissection has no fascia visible with the prostate capsule exposed (clear Foley balloon indicated by white arrow) and the neurovascular bundle completely pushed away between both fascial layers. The artwork in part B is published with the permission of Shelley L.W. Chen, University of Toronto, Biomedical Communications Department.

• 

  FIG. 2 The simple prostatectomy model using a clementine. The model in this iteration was not modified to be fixed on foam or cardboard and has no urethra, thus highlighting the simplest form it may take yet still be instructional. For a retropubic approach, hemostatic sutures are first applied to the capsule (A) before incision (B) of the capsule (skin). The pulp (adenoma) is then dissected off the capsule (C) and finally carefully removed from the capsule, preferably intact, with the capsule closed (skin) with sutures (D).

• 

  FIG. 3 The simple prostatectomy model using a clementine as modified to be fixed on foam or cardboard and to have a urethra. A party balloon is inserted into the centre of the fruit (A) as the urethra and is later tied to the foam board. The urethra can be stretched as in real cases (B) before being formally incised. The blue suture fixing the base of the prostate model to the foam board (A and C) acts as a bleeding vessel to oversew when the pulp (adenoma) has been removed (in this case the skin [capsule] is split to demonstrate fixation to the foam board).

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