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Simulation Training in Penile Implant Surgery

posted: February 22, 2019

Assessment of Surgical Confidence and Knowledge With Cadaveric Laboratory Training

Dear SUPS Membership,

Traditionally, surgical technical skills have been acquired by observing and then performing surgical tasks in a “see one... do one ...teach one” model solely within the operating room. Although operative experience is paramount, the lack of formal teaching and testing of surgical skills in a safe practice environment remains a longstanding educational shortcoming of this traditional paradigm.

Unfortunately, constraints on surgical resident training, including work hour mandates, shorter training programs, costs, and public expectations, are limiting the acquisition of surgical skills in the operating room. As a result, more limited regional and national simulation training courses are being conducted to augment the resident experience.

At the 2017 SMSNA fall meeting in San Antonio, we set out to assess the educational effect of the SUPS/SMS Surgical lab for Residents. This is an intensive half-day lab open to resident trainees from around the country. SUPS and SMS members provide both didactic and hands on training for residents interested in prosthetic Urology.

Thirty-one residents (median age: 30 years old; 24 males: 7 female) participated in this study. The majority of the participants were fourth (41.9%) and fifth year residents (38.7%). Pre-course surgical exposure to penile prosthetic surgery consisted of less than 10 (35.5%), 10-20 (45.2%), and more than 20 cases (19.3%) for course participants. Participants showed a significant improvement in procedural knowledge test scores (68.8±13.4 vs. 74.2 ± 13.0, p<0.05) and self-reported increased median surgical confidence levels (4 vs 3, p-value <0.001) after completion of the cadaveric course. Subgroup analysis demonstrated that residents with prosthetic surgery experience of less than 10 cases benefitted the most. In addition, improvement in surgical confidence levels observed was greater than the improvement in surgical knowledge.

One of the most important findings of this study was that 41.9% of participants did not feel confident placing the reservoir the space of Retzius or in a submuscular location. However, by the end of the course, 90.3% of the residents reported feeling confident placing the reservoir. As voiced by the trainees during the course, this was the surgical step which was the most anxiety provoking. The average cost of the simulation training course (air fare logging, meals and meeting registration) was $1,483 per resident, which was possible thanks to an unrestricted educational grant from Coloplast and Boston Scientific.

This prospective IRB study supports for the first time in urology that simulation surgical training and didactic lectures by expert proctors may be an effective educational method to improve knowledge and self-reported operative confidence in urology residents performing penile prosthesis surgery. The findings in this study are consistent with prior studies in other surgical sub-specialties investigating the benefits of practical, anatomical and procedural training in cadaveric labs. Based on this study, we strongly feel that simulation training in prosthetic urology is a critical component of urology residency. Further research is needed to better understand the benefits and limitations of cadaveric simulating training in prosthetic urology.

Warm regards,

Aaron Lentz
SUPS Member-At-Large

Read the Full Study