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Realistic anatomical prostate models for surgical skills workshops using ballistic gelatin for nerve-sparing radical prostatectomy and fruit for simple prostatectomy.

Lawrentschuk N, Lindner U, Klotz L - Korean J Urol (2011)

Bottom Line: Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function.Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP.The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada.

ABSTRACT

Purpose: Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function. The objectives of this study were to develop inexpensive and simple but anatomically accurate prostate models not involving human or animal elements to teach the terminology and practical aspects of nerve-sparing RP and simple prostatectomy (SP).

Materials and methods: The RP model used a Foley catheter with ballistics gelatin in the balloon and mesh fabric (neurovascular bundles) and balloons (prostatic fascial layers) on either side for the practice of inter- and intrafascial techniques. The SP model required only a ripe clementine, for which the skin represented compressed normal prostate, the pulp represented benign tissue, and the pith mimicked fibrous adhesions. A modification with a balloon through the fruit center acted as a "urethra."

Results: Both models were easily created and successfully represented the principles of anatomical nerve-sparing RP and SP. Both models were tested in workshops by urologists and residents of differing levels with positive feedback.

Conclusions: Low-fidelity models for prostate anatomy demonstration and surgical practice are feasible. They are inexpensive and simple to construct. Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP. The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive.

No MeSH data available.


Related in: MedlinePlus

The simple prostatectomy model using a clementine as modified to be fixed on foam or cardboard and to have a urethra. A party balloon is inserted into the centre of the fruit (A) as the urethra and is later tied to the foam board. The urethra can be stretched as in real cases (B) before being formally incised. The blue suture fixing the base of the prostate model to the foam board (A and C) acts as a bleeding vessel to oversew when the pulp (adenoma) has been removed (in this case the skin [capsule] is split to demonstrate fixation to the foam board).
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Figure 3: The simple prostatectomy model using a clementine as modified to be fixed on foam or cardboard and to have a urethra. A party balloon is inserted into the centre of the fruit (A) as the urethra and is later tied to the foam board. The urethra can be stretched as in real cases (B) before being formally incised. The blue suture fixing the base of the prostate model to the foam board (A and C) acts as a bleeding vessel to oversew when the pulp (adenoma) has been removed (in this case the skin [capsule] is split to demonstrate fixation to the foam board).

Mentions: The skin of the clementine acts as the compressed normal prostate tissue, as happens with significant benign prostatic hyperplasia adenoma formation (Fig. 2). The pulp (segments within) acts as the prostate tissue, and the white fibrous adhesions of the pith from fruit to skin mimic adhesions in humans. To make the model more anatomical, we pulled a balloon through the center of the fruit by its neck after scissors grasped by needle holders were passed through (Fig. 3). Once pulled through, the balloon was tied to the other side to fix it in place. This formed the "prostatic urethra" that must be deliberately incised at the time of prostatectomy.


Realistic anatomical prostate models for surgical skills workshops using ballistic gelatin for nerve-sparing radical prostatectomy and fruit for simple prostatectomy.

Lawrentschuk N, Lindner U, Klotz L - Korean J Urol (2011)

The simple prostatectomy model using a clementine as modified to be fixed on foam or cardboard and to have a urethra. A party balloon is inserted into the centre of the fruit (A) as the urethra and is later tied to the foam board. The urethra can be stretched as in real cases (B) before being formally incised. The blue suture fixing the base of the prostate model to the foam board (A and C) acts as a bleeding vessel to oversew when the pulp (adenoma) has been removed (in this case the skin [capsule] is split to demonstrate fixation to the foam board).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3045719&req=5

Figure 3: The simple prostatectomy model using a clementine as modified to be fixed on foam or cardboard and to have a urethra. A party balloon is inserted into the centre of the fruit (A) as the urethra and is later tied to the foam board. The urethra can be stretched as in real cases (B) before being formally incised. The blue suture fixing the base of the prostate model to the foam board (A and C) acts as a bleeding vessel to oversew when the pulp (adenoma) has been removed (in this case the skin [capsule] is split to demonstrate fixation to the foam board).
Mentions: The skin of the clementine acts as the compressed normal prostate tissue, as happens with significant benign prostatic hyperplasia adenoma formation (Fig. 2). The pulp (segments within) acts as the prostate tissue, and the white fibrous adhesions of the pith from fruit to skin mimic adhesions in humans. To make the model more anatomical, we pulled a balloon through the center of the fruit by its neck after scissors grasped by needle holders were passed through (Fig. 3). Once pulled through, the balloon was tied to the other side to fix it in place. This formed the "prostatic urethra" that must be deliberately incised at the time of prostatectomy.

Bottom Line: Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function.Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP.The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada.

ABSTRACT

Purpose: Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function. The objectives of this study were to develop inexpensive and simple but anatomically accurate prostate models not involving human or animal elements to teach the terminology and practical aspects of nerve-sparing RP and simple prostatectomy (SP).

Materials and methods: The RP model used a Foley catheter with ballistics gelatin in the balloon and mesh fabric (neurovascular bundles) and balloons (prostatic fascial layers) on either side for the practice of inter- and intrafascial techniques. The SP model required only a ripe clementine, for which the skin represented compressed normal prostate, the pulp represented benign tissue, and the pith mimicked fibrous adhesions. A modification with a balloon through the fruit center acted as a "urethra."

Results: Both models were easily created and successfully represented the principles of anatomical nerve-sparing RP and SP. Both models were tested in workshops by urologists and residents of differing levels with positive feedback.

Conclusions: Low-fidelity models for prostate anatomy demonstration and surgical practice are feasible. They are inexpensive and simple to construct. Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP. The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive.

No MeSH data available.


Related in: MedlinePlus