Nadu Andrei, Olsson Lief Eric, Abbou Claude Clement
Department of Urology, The Haim Sheba Medical Center, Tel Hashomer, Israel.
J Endourol. 2003 Sep;17(7):481-4. doi: 10.1089/089277903769013621.
To create a simple model for training in the complex technique of laparoscopic vesicourethral anastomosis after radical prostatectomy.
A model simulating the performance of a laparoscopic running urethrovesical anastomosis was fashioned using skin of a supermarket chicken set in a laparoscopic training box. A circular continuous anastomosis was performed, following exactly the technique we use in vivo for performing a vesicourethral anastomosis after laparoscopic radical prostatectomy. Details regarding the use of the right or the left needle holder, needle positioning, precise stitch position, and use of forehand or backhand stitch were strictly respected in order to reproduce the continuous stitch currently done in vivo in our department. The learning curve was analyzed in terms of the time necessary to perform the task and the quality of the anastomosis.
The model was created and used by the junior authors during their year of fellowship in advanced laparoscopic urology. The authors had no previous experience with hands-on laparoscopic suturing but have assisted in a great number of laparoscopic radical prostatectomies. The time required for performing the anastomosis on the model declined from 75 minutes initially to 20 minutes after the trainees had performed 20 anastomoses each. After this training, it was possible to create a watertight running laparoscopic vesicourethral anastomosis in patients in a mean time of 40 minutes (range 30-55 minutes).
This simple model allows the trainee in laparoscopic urology to acquire the skills necessary to perform a laparoscopic vesicourethral anastomosis, one of the most complex steps in laparoscopic radical prostatectomy, as well as to develop dexterity and facility in laparoscopic manipulation of needles, sutures, and fragile tissues.
创建一个简单模型，用于在根治性前列腺切除术后腹腔镜膀胱尿道吻合这一复杂技术的训练。
利用超市购买的鸡皮置于腹腔镜训练箱内制作一个模拟腹腔镜连续尿道膀胱吻合操作的模型。进行环形连续吻合，严格遵循我们在体内进行腹腔镜根治性前列腺切除术后膀胱尿道吻合所使用的技术。在使用右或左持针器、针的定位、精确的缝合位置以及使用正手或反手缝合方面的细节都得到严格遵循，以便重现目前我们科室在体内进行的连续缝合。从完成任务所需时间和吻合质量方面分析学习曲线。
该模型由初级作者在其高级腹腔镜泌尿外科 fellowship 年度创建并使用。作者此前没有腹腔镜缝合的实践经验，但协助进行了大量腹腔镜根治性前列腺切除术。在模型上进行吻合所需时间从最初的 75 分钟降至每位学员进行 20 次吻合后 20 分钟。经过此训练后，在患者中平均 40 分钟（范围 30 - 55 分钟）即可创建一个防水的腹腔镜连续膀胱尿道吻合。
这个简单模型使腹腔镜泌尿外科培训学员能够掌握进行腹腔镜膀胱尿道吻合所需的技能，这是腹腔镜根治性前列腺切除术中最复杂的步骤之一，同时还能培养在腹腔镜下操作针、缝线和脆弱组织的灵活性和熟练度。
