Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA.
Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, USA; Morgridge Institute for Research, Madison, WI, USA.
J Pediatr Urol. 2022 Dec;18(6):765.e1-765.e6. doi: 10.1016/j.jpurol.2022.04.020. Epub 2022 May 7.
Hypospadias repair is an index pediatric urology procedure that requires trainee familiarity with surgical loupes. A previous low-fidelity, 6-step curriculum was proposed that deconstructed the most important steps of loupe surgery. We expanded on this curriculum with an intermediate-fidelity silicone hypospadias model and designed an abbreviated version of the 6-step curriculum to precede the hypospadias repair simulation.
To assess the validity of our prior, low-fidelity conceptual model using the metric of improved performance on the intermediate-fidelity silicone hypospadias model.
A silicone model was first prototyped with the design software Solidworks™, and then fabricated using a cast made of a mixture of silicone rubbers designed to function like skin and soft tissue (Mold Star 20T, Dragon skin FX-pro and Slacker). Casts were used to create the penile shaft model and the dorsal hooded foreskin model. The urethral plate was cast separately on a flat surface. The model was then assembled by hand. The model used for simulation included the penile shaft and urethral plate, while the dorsal-hooded foreskin was prepared to simulate the penile anatomy separately. Trainees were then divided into two groups. Group 1 practiced the low-fidelity curriculum (3 tasks) and then performed dissection of the urethral plate and suturing using the intermediate-fidelity hypospadias model. Group 2 practiced hypospadias repair prior to the low-fidelity curriculum. Both groups' models were scored by 3 blinded urologists. Trainees were then asked to complete a post simulation satisfaction survey. Data analysis was performed in IBM SPSS Statistics for Macintosh (Version 28.0 Armonk, NY: IBM Corp).
Twenty-two candidates across Wisconsin, USA, and Dublin, Ireland participated in the study. This included 7 s-year residents, 9 third-year residents, 2 fourth-year residents, and 3 fifth-year residents. Both Groups 1 and 2 had a similar distribution of trainees (p = 0.60). Group 1 outperformed group 2 in all tasks (p < 0.05, Table 1). Trainees reported that the platform was very useful (91%).
Our curriculum showed improvement in trainee ability and comfort to perform hypospadias repair. Advantages of such a simulated curriculum include improving current resident training in microsurgery, improving surgical ergonomics for trainees prior to real-time experience, and decreasing the learning curve for trainees pursuing pediatric urology.
An intermediate-fidelity hypospadias platform externally validates the conceptual model implemented in the low-fidelity loupes curriculum. This appears to lead to improvement in loupe surgical skills regardless of trainee level.
尿道下裂修复是小儿泌尿外科的一项专业手术，需要受训者熟悉手术放大镜的使用。先前提出了一个低保真度的 6 步课程，该课程分解了使用放大镜手术最重要的步骤。我们使用中保真度的硅胶尿道下裂模型扩展了这个课程，并设计了 6 步课程的简化版本，作为尿道下裂修复模拟的前置课程。
使用中间保真度的硅胶尿道下裂模型来评估我们之前低保真度概念模型的有效性，其评估标准是在该模型上的表现有所提高。
首先使用 Solidworks™设计软件对硅胶模型进行原型设计，然后使用由设计为模拟皮肤和软组织的硅橡胶混合物制成的模具进行铸造（Mold Star 20T、Dragon skin FX-pro 和 Slacker）。使用模具制作阴茎轴模型和背侧帽状包皮模型。尿道板单独在一个平面上铸造。然后通过手工组装模具。用于模拟的模型包括阴茎轴和尿道板，而背侧帽状包皮则单独准备以模拟阴茎解剖结构。然后将受训者分为两组。第 1 组练习低保真度课程（3 个任务），然后使用中间保真度的尿道下裂模型进行尿道板切开和缝合。第 2 组在低保真度课程之前进行尿道下裂修复练习。3 位盲法泌尿科医生对两组模型进行评分。然后，让受训者完成模拟后满意度调查。数据分析使用 IBM SPSS Statistics for Macintosh（版本 28.0，Armonk，NY：IBM Corp）进行。
来自美国威斯康星州和爱尔兰都柏林的 22 名候选人参加了这项研究。这包括 7 名住院医师、9 名三年级住院医师、2 名四年级住院医师和 3 名五年级住院医师。第 1 组和第 2 组的受训者分布相似（p=0.60）。第 1 组在所有任务中的表现均优于第 2 组（p<0.05，表 1）。受训者报告称该平台非常有用（91%）。
我们的课程显示出受训者进行尿道下裂修复的能力和舒适度有所提高。这种模拟课程的优点包括改善当前住院医师的微创手术培训、改善受训者在实时体验之前的手术人体工程学，以及减少从事小儿泌尿外科的受训者的学习曲线。
中间保真度的尿道下裂平台从外部验证了在低保真度的放大镜课程中实施的概念模型。这似乎可以提高放大镜手术技能，无论受训者的水平如何。
