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External validation of a low fidelity dry-lab platform to enhance loupes surgical skills techniques for hypospadias repair

  • V.P. Bhatia
    Correspondence
    Correspondence to: Vinaya P. Bhatia, University of Wisconsin at Madison, 1685 Highland Ave, Madison, WI, 53705, USA. Tel.: +(608) 263 9534; fax: +(608) 262 6453
    Affiliations
    Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA
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  • J. Wolf
    Affiliations
    Department of Biomedical Engineering, University of Wisconsin–Madison College of Engineering, USA

    Morgridge Institute for Research, Madison, WI, USA
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  • W.A. Farhat
    Affiliations
    Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA
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  • B. Lewis
    Affiliations
    Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA
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  • D.R. Gralnek
    Affiliations
    Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA
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  • K.W. Eliceiri
    Affiliations
    Department of Biomedical Engineering, University of Wisconsin–Madison College of Engineering, USA

    Morgridge Institute for Research, Madison, WI, USA
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  • F. O'Kelly
    Affiliations
    Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA

    Division of Paediatric Urology, Beacon Hospital, University College Dublin, Ireland
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      Summary

      Introduction

      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.

      Objective

      To assess the validity of our prior, low-fidelity conceptual model using the metric of improved performance on the intermediate-fidelity silicone hypospadias model.

      Study design

      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).

      Results

      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%).

      Discussion

      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.

      Conclusion

      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.

      Keywords

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