Design and Validation of a Low-cost, High-fidelity Model for the Urethrovesical Anastomosis in Radical Prostatectomy.

OBJECTIVE: We sought to develop and validate a low-cost, high fidelity robotic surgical model for the urethrovesical anastomosis component of the robotic assisted laparoscopic radical prostatectomy.

METHODS: A novel simulation model was constructed using a 3D-printed model of the male boney pelvis from CT scan data and silicone molds to recreate the soft tissue aspects. Using a DaVinci Si surgical robot, urology faculty and trainees performed simulated urethral-vesical anastomosis. Each participant was given 12 minutes to complete the simulation. A survey established face validity, content validity, and acceptability. Simulation runs were evaluated by three blinded reviewers. The anastomosis was graded by two reviewers for suture placement accuracy and anastomosis quality. These factors were compared to robotic experience to establish construct validity.

RESULTS: Twenty participants took part in the initial validation of this model. Groups were defined as experts (surgical faculty), intermediate (fellows and chief residents), and novices (junior residents). Likert scores (1-5 scale, top-score 5) examining face validity, content validity, and acceptability were 3.49 ± 0.43, 4.15 ± 0.23, and 4.02 ± 0.19, respectively. Construct validity was excellent based on the model's ability to stratify groups. All evaluated metrics were statistically different between the three levels of training. Total material cost was $2.50 per model.

CONCLUSIONS: We developed a novel low-cost robotic simulation of the urethrovesical anastomosis for robotic assisted radical prostatectomy. The model discerns robotic skill level across all levels of training and was found favorable by participants showing excellent face, content and construct validity.