Cairo University, Faculty of Medicine (Kasr Alainy), Cairo University Hospitals, Paediatric Surgery Section/Units (Departments of General Surgery), Cairo University Specialized Paediatric Hospital [CUSPH] & Cairo University Children's Hospital [Abu El-Reesh El-Mounira], 11562, Cairo, Egypt.
American Hospital Dubai, Oud Maitha, Dubai & Gulf Medical University, Ajman, United Arab Emirates; King's College Hospital London, Dubai Branch, United Arab Emirates.
J Pediatr Urol. 2024 Aug;20(4):607.e1-607.e11. doi: 10.1016/j.jpurol.2024.01.006. Epub 2024 Jan 12.
INTRODUCTION: Simulated paediatric surgical training is inherently advantageous and flourishing. Moreover, several working conditions resulted in reduced training hours, index and subspecialty cases encountered, and the COVID-19 pandemic affected elective surgery backlogs, hence training opportunities. Hypospadias repair is technically-demanding and requires a spectrum of dissective and reconstructive skills. We therefore aimed to test a 3D-printed silicon model for hypospadias repair, in the context of hands-on surgical training. MATERIAL AND METHODS: Twenty-Seven trainees, under the supervision of 15 instructors, completed the activity. They were given a seminar to show the relevant anatomy, and 8 key steps of the exercise: (1)-degloving; (2)-urethral plate marking; (3)-incision; (4)-tubularisation; (5)-glansplasty/glanuloplasty; (6)-dartos layer preparation; (7)-preputioplasty and (8)-skin closure. Each trainee completed a structured feedback assessment. An on-site trainer supervised and evaluated each exercise. Trainees and trainers rated the model through the above steps from unsatisfactory-(1/5) to excellent-(5/5), presented herein via cross-sectional analysis. RESULTS: Eleven-(40.7 %) trainees were in years:1-3 of specialist training, 10-(37 %) were in years:4-6, and 6-(22.2 %) were beyond year-6. Two-(7.4 %) trainees had nil-hypospadias experience, 16-(59.2 %) previously assisted in procedures or performed steps, 5-(18.5 %) performed whole procedures supervised and 4-(14.8 %) independently. Twenty-(74 %) trainees and 15-(100 %) instructors judged the model to resemble the anomaly. Seventeen-(63 %) trainees and 13-(86.6 %) instructors rated the material needle-penetrability ≥3/5, compared to human tissue. Sixteen-(59 %) trainees and 13-(86.6 %) instructors rated the material suture holding ≥3/5. Eleven-(73.3 %) trainees and 13-(86.6 %) instructors rated sutures' evenness and edge coaptability ≥3/5. DISCUSSION: Hypospadias is an index operation, which requires precision skills. Simulated training in Paediatric Surgery and Urology is gaining importance. 3D-printed models are gaining a key role in simulated training. The study presents a novel 3D-printed high-fidelity silicon-based hypospadias model designed for hands-on training. A structured pathway to divide a standard hypospadias repair into key steps is displayed to ensure skill acquisition and stabilisation. CONCLUSION: This 3D-printed silicon-based hypospadias model is proven useful for hands-on training. The fidelity can still improve, especially regarding suture holding of the material. LEVEL OF EVIDENCE: LEVEL III.
简介:模拟小儿外科学术培训具有内在优势并且蓬勃发展。此外,一些工作条件导致培训时间、索引和亚专科病例减少,以及 COVID-19 大流行影响了择期手术积压,因此培训机会减少。尿道下裂修复技术要求高,需要一系列的解剖和重建技能。因此,我们旨在测试一种用于尿道下裂修复的 3D 打印硅模型,作为实践手术培训的一部分。
材料和方法:在 15 名指导员的监督下,27 名学员完成了该活动。他们参加了一个研讨会,展示了相关的解剖结构,以及 8 个关键步骤:(1)脱套;(2)尿道板标记;(3)切开;(4)管状化;(5)龟头成形术/龟头成形术;(6)dartos 层准备;(7)包皮成形术和(8)皮肤闭合。每位学员都完成了结构化的反馈评估。一名现场指导员监督和评估了每个练习。学员和指导员通过上述步骤对模型进行评分,从不满意(1/5)到优秀(5/5),通过横断面分析在此呈现。
结果:11 名(40.7%)学员处于专科培训的 1-3 年,10 名(37%)处于 4-6 年,6 名(22.2%)超过 6 年。2 名(7.4%)学员没有尿道下裂经验,16 名(59.2%)之前曾协助过手术或完成过步骤,5 名(18.5%)在监督下完成了整个手术,4 名(14.8%)独立完成。20 名(74%)学员和 15 名(100%)指导员认为模型与异常相似。17 名(63%)学员和 13 名(86.6%)指导员认为材料的针穿透性≥3/5,与人体组织相比。16 名(59%)学员和 13 名(86.6%)指导员认为材料的缝线保持性≥3/5。11 名(73.3%)学员和 13 名(86.6%)指导员认为缝线的均匀性和边缘吻合性≥3/5。
讨论:尿道下裂是一种指数手术,需要精确的技能。小儿外科学和泌尿科的模拟培训越来越重要。3D 打印模型在模拟培训中扮演着重要角色。本研究提出了一种新的用于实践培训的 3D 打印高保真硅基尿道下裂模型。展示了一种将标准尿道下裂修复术分解为关键步骤的结构化方法,以确保技能的获取和稳定。
结论:这种基于 3D 打印的硅基尿道下裂模型已被证明可用于实践培训。其逼真度仍有待提高,特别是材料的缝线保持性。
证据水平:III 级。
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