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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A practice platform for systematic development of microsurgical instrument technique.Cureus. 2017; 9e1253
- Animal ethics in laparoscopic urology training.Turk J Urol. 2017; 43: 429
- Survey of microsurgery training availability in US urology residency programs.World J Mens Health. 2021; 39: 376
- Objective structured assessment of technical skill (OSATS) for surgical residents.Br J Surg. 1997; 84: 273
- Surgical ergonomics for urologists: a practical guide.Nat Rev Urol. 2021; 18: 160
- Is there an increased incidence of cervical degenerative disease in surgeons who use loupes and a headlight?.J Spine. 2015; 4
- A multiplanar simulator for hypospadias repair.Eur J Plast Surg. 2020; 44: 139
- gtsimulators.com/products/hypospadia-surgical-simulator-kit-hpt#BeginDescription: GTSimulators)1 ed. Hypospadias surgical simulator kit. vol. 2022. 2022 (With 8 simulations of malformation of the urethra, the Hyspospadia Trainer (HPT) allows clinical analysis and surgical considerations for each case, according to its presentation. Includes proximal, distal, midshaft, and glanular hypospadias.) (
- The learning curve in proximal hypospadias repair.J Pediatr Urol. 2021; 17: 330 e1
- Impact of changing trends in technique and learning curve on outcome of hypospadias repair: an experience from tertiary care center.Indian J Urol. 2016; 32: 216
- Competency in tubularized incised plate repair for distal hypospadias: cumulative sum learning curve analysis of a single surgeon experience.J Urol. 2020; 204: 1326
Article info
Publication history
Published online: May 07, 2022
Accepted:
April 30,
2022
Received in revised form:
April 22,
2022
Received:
February 15,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.