The University of Maryland-Surgery, Baltimore, MD 21201, USA.
J Sex Med. 2010 Mar;7(3):1298-305. doi: 10.1111/j.1743-6109.2009.01588.x. Epub 2009 Nov 19.
Emphasis should be placed on assessing resident education. At our institution, the trans-scrotal (TS) approach for inflatable penile prosthesis (IPP) surgery has been widely taught, with infrapubic (IP) approach recently introduced. Feedback and trends on learning a new implant technique is assessed. Aim. The aim is to understand the advantages and pitfalls of a surgical approach through residents in training. This will provide insight into resident education for teaching physicians and a framework for understanding how to teach the two approaches.
The outcomes measured will be the residents' reflection on the ease of different steps of the infrapubic procedure upon finishing 15 sequential cases as well as feeling about the end result and time it took to complete the operation.
Two senior residents with experience of over 100 TS implants recorded impressions on their first 15 infrapubic IPP cases via questionnaire. IPP was compared with TS with regard to reservoir, cylinder, pump placement, surgical exposure, and resident involvement. Scores of 1-5 were given, with 1 implying harder or more difficult, 3 the same, and 5 better or easier.
Proximal dilatation and cylinder placement remained superior for the IP approach, but distal cylinder placement posed major challenges for the IP surgery. Pump placement was more difficult and remained so for the IP approach, yet reservoir placement was similar. Residents' sense of involvement was superior early on for the IP procedure. Operating room time improved steadily for the IP approach and ultimately was faster than implants placed trans-scrotally.
The IP approach is quickly learned by residents. Resident placement with the IP approach offers no advantage for the experienced resident. Pump placement and distal dilatation began and remain challenging. Location of corporotomy is the most challenging component and dictates difficulty of dilatation. Residents gain early confidence with the IP approach.
应重视住院医师教育。在我们的机构中，充气式阴茎假体 (IPP) 手术的经阴囊 (TS) 入路已广泛教授，最近也引入了经耻骨 (IP) 入路。评估学习新植入技术的反馈和趋势。目的：目的是通过受训住院医师了解手术入路的优缺点。这将为教学医师提供住院医师教育方面的深入了解，并为理解如何教授这两种方法提供框架。
测量的结果将是住院医师在完成 15 例连续病例后对耻骨入路不同步骤的难易程度的反思，以及对最终结果和完成手术所需时间的感受。
两位有超过 100 例 TS 植入经验的资深住院医师通过问卷记录了他们对前 15 例耻骨 IPP 病例的印象。IPP 与 TS 相比，在储液器、圆柱体、泵的放置、手术暴露和住院医师参与方面进行了比较。评分 1-5，1 表示更难或更困难，3 表示相同，5 表示更好或更容易。
近端扩张和圆柱体放置对于 IP 入路仍然具有优势，但对于 IP 手术，远端圆柱体放置具有很大的挑战性。泵的放置对于 IP 入路来说更加困难，而且仍然如此，但储液器的放置则相似。住院医师早期对 IP 手术的参与感更好。对于 IP 入路，手术室时间稳步提高，最终比经阴囊入路放置的假体更快。
IP 入路很快被住院医师掌握。对于经验丰富的住院医师来说，IP 入路的住院医师放置没有优势。泵的放置和远端扩张开始并一直具有挑战性。尿道切开部位是最具挑战性的部分，决定了扩张的难度。住院医师对 IP 入路早期充满信心。
