Xue Jing-Dong, Zhang Ping, Xu Yue-Min, Sa Ying-Long, Shu Hui-Quan, Wang Lin, Xie Hong, Li Chao, Zhang Wei, Feng Chao, Wu Deng-Long
Department of Urology Tongji Hospital, School of Medicine, Tongji University Shanghai China.
Department of Reproductive Medicine The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai China.
BJUI Compass. 2024 Aug 30;5(10):916-923. doi: 10.1002/bco2.426. eCollection 2024 Oct.
This study aimed to report a newly developed, high-fidelity synthetic simulator to simulate excision and primary anastomotic (EPA) bulbar urethroplasty and its clinical use for new practitioners in shortening the learning curve.
The bulbar urethral anastomosis simulator consists of several standardized components created according to the actual size of the male patient. Interns, novice residents, and fellows inexperienced with urethral reconstruction ( = 10, 5, 5) from different medical centres were invited to participate in the training programme. Two reconstructive urology experts monitored each practice. Following the training, three kinds of validity testing were used to assess the simulator: face, content, and construct. In the intern group, the task performance in the first five training sessions and the last five training ones were compared using a self-control approach. In the resident and fellow group, the real surgical data, including estimated blood loss, operative duration, and 6-month post-operative success rate of trainees after training, are plotted, which are compared with that of reconstructive urology experts ( = 5) included retrospectively to study the effectiveness of the simulator in shortening the learning curve.
The overall mean satisfaction rate for the simulators was inspiring and evaluated by experts. In the intern group, significant improvement can be achieved through 10 training sessions ( < 0.05). In clinical practice, the intraoperative indicators and surgical success rate of both the training groups showed the tendency to close or even better than those in the expert group. In terms of the learning curve, training groups performed better compared with experts in the early stages of their careers.
In conclusion, this synthetic training simulator for bulbar urethral anastomosis is novel, effective, and convenient for beginners of different groups. The training course can bridge the gap between preclinical use and actual surgery via this simulator.
本研究旨在报告一种新开发的高保真合成模拟器，用于模拟球部尿道切除及一期吻合术（EPA），并阐述其在缩短新从业者学习曲线方面的临床应用。
球部尿道吻合模拟器由根据男性患者实际尺寸制作的多个标准化部件组成。邀请了来自不同医疗中心、未接触过尿道重建的实习生、低年资住院医师和进修医师（分别为10名、5名、5名）参加培训项目。两名重建泌尿外科专家对每次操作进行监督。培训结束后，采用三种效度测试来评估模拟器：表面效度、内容效度和结构效度。在实习生组中，采用自身对照法比较前五次和后五次培训的任务表现。在住院医师和进修医师组中，绘制培训后学员的实际手术数据，包括估计失血量、手术时长和术后6个月成功率，并与回顾性纳入的重建泌尿外科专家（5名）的数据进行比较，以研究模拟器在缩短学习曲线方面的有效性。
专家对模拟器的总体平均满意度令人鼓舞。在实习生组中，经过10次训练可取得显著进步（<0.05）。在临床实践中，两个培训组的术中指标和手术成功率均呈现出接近甚至优于专家组的趋势。在学习曲线方面，培训组在职业生涯早期的表现优于专家。
总之，这种用于球部尿道吻合的合成训练模拟器新颖、有效且方便不同群体的初学者使用。该培训课程可通过此模拟器弥合临床前使用与实际手术之间的差距。
