The following is the summary of “External validation of a low fidelity dry-lab platform to enhance loupes surgical skills techniques for hypospadias repair” published in the December 2022 issue of Pediatric urology by Bhatia, et al.
When learning pediatric urology, residents and fellows must become comfortable using surgical loupes, as hypospadias correction is an index surgery. There was once a proposal for a low-fidelity, 6-step program that broke down the key processes of loupe surgery. Researchers developed an abridged 6-step curriculum to be used before the hypospadias repair simulation and supplemented it with a silicone hypospadias model. The purpose of this exercise is to evaluate the efficacy of their previous, low-fidelity conceptual model by measuring how well it fares in comparison to the intermediate-fidelity silicone hypospadias model. SolidworksTM was used to create a prototype of the silicone model, and then a cast was constructed out of a silicone rubber mixture meant to mimic skin and soft tissue (Mold Star 20T, Dragon skin FX-pro and Slacker).
The penile shaft model and the dorsal hooded foreskin model were both made from casts. Separately, on a flat surface, the urethral plate was cast. The parts were then painstakingly assembled by hand. The penile shaft and urethral plate were incorporated in the model used for simulation, and the dorsal-hooded foreskin was produced to replicate the penile anatomy independently. After that, the trainees were split into 2 equal halves. The first group worked on the low-fidelity curriculum (3 tasks) before moving on to the intermediate-fidelity hypospadias model for dissection of the urethral plate and suturing. The second group had experience with hypospadias correction before being exposed to the low-fidelity training. Next, 3 blinded urologists evaluated the models created by both teams. Next, participants were given a survey to fill out about their experience with the simulation. IBM SPSS Statistics for Mac was used to analyze the data (Version 28.0 Armonk, NY: IBM Corp).
A total of 22 potential candidates from Wisconsin, United States, and Dublin, Ireland, took part in the research. 7 1st, 9 3rd-years, 2 4th, and 3 5th made up the total. The distribution of students in Groups 1 and 2 was comparable (P=0.60). All tasks were completed more successfully by Group 1 than by Group 2 (P<0.05, Table 1). Many trainees (91%) found the site to be really helpful. The competence and confidence of their trainees to conduct hypospadias correction increased as a result of our training program. Training residents in microsurgery using a simulated curriculum has many benefits, including better surgical ergonomics for trainees before they get hands-on experience and a shorter learning curve for those interested in pediatric urology. The hypospadias platform at the intermediate fidelity level provides independent confirmation of the conceptual model used in the low fidelity loupes training. It seems that this helps students of all experience levels become more proficient in loupe surgery.