Category: Education, Simulation & Virtual Reality

MP33-13 - Usefulness of Fresh Frozen Cadaver and Animal Models for Surgical Training in Laparoscopic Sacrocolpopexy

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Pelvic organ prolapse (POP) has a prevalence of 3-6% when based on symptoms and up to 50% when based on vaginal examination. For surgical treatment of POP, laparoscopic sacrocolpopexy (LSC) has become popular in Japan because of lower rates of recurrence, lower estimated blood loss and shorter hospital length. LSC learning is a challenge for urologists, since LSC requires advanced endoscopic dissection and suturing skills and understanding female pelvic anatomy. The aim of this study is to create a novel fresh frozen cadaver and animal training model for LSC to reduce the learning curve.


Methods :

We invited an expert as a lecturer, and learned female pelvic anatomy, procedure and techniques of LSC using fresh frozen cadavers. After the LSC procedure we dissected around the vagina and recognized the location of bilateral ureter and rectum not to cause injury. In animal surgical training center LSC was performed uneventfully in female pig. Laparoscopic trocars were situated like human, and a subtotal hysterectomy, dissection of vagina and fixation of mesh to anterior and posterior vagina were carried out. The tail of both meshes was sutured to the sacral promontory using nonabsorbable sutures. Urology residents performed bilateral laparoscopic nephrectomy to learn laparoscopic technique from spirits of animal welfare at the same training. We did a questionnaire survey by these training.


Results :

Nine urologists participated the fresh frozen cadaver training for LSC. Questionnaire survey was carried out about procedure, development of surgical field, endoscopic surgical technique and suturing skills. All participants (2 residents, 5 beginners experiencing other laparoscopic surgery, 2 experienced LSC) answered the training was effective, and self-assessments were 43-100 points out of 100 points. In animal laboratory, training was performed in 3 steps, dissection and suturing of the promontory, dissection of the vaginal vault and fixation of mesh. 2 LSC beginners experienced other laparoscopic procedure started these training. It is now possible to complete all steps with no trouble by 5 trainings with a total of 2 to 5 hours of training. The time taken for one step has also been shortened each time it is repeated.


Conclusions :

We consider the laboratory fresh cadaver and animal training model is suitable for training on LSC. However, further study is necessary to evaluate the usefulness of this training method objectively.

Yasuyo Yamamoto

Lecturer
The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

NAME: Yasuyo Yamamoto (Female)
DATE and PLACE OF BIRTH: 27/Mar/1972 (Osaka, Japan)

PRESENT ADDRESS:
OFFICE: 3-18-15 Kuramoto-cho Tokushima City Japan, Zip 770-8503
TEL: +81-88-633-7159 FAX: +81-88-633-7160

EDUCATION:
1990 Graduated from Chiba Prefectural Chiba Highschool (Chiba)
1996 Graduated from Saga University, School of Medicine
2004 Received Ph.D. in medicine from Tokushima University

LICENSURE and CERTIFICATION:
National Board of Medicine, Registration No. 378519
Japanese Board of Urology, No. 20010225
Japanese Board of Continence, No. 0099

MEMBERSHIPS:
The Japanese Urological Association, Japanese Society of Endourology
Japan Continence Society, the Japanese Society of Female Pelvic Floor Medicine,
International Continense Societty. International Urogynecological Association

MAJOR RESEARCH INTERESTS:
Female Urology, Pelvic Organ Prolapse, Interstitial Cystitis

Tomoya Fukawa

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Yoshito Kusuhara

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Megumi Tsuda

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Kei Daizumoto

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Keisuke Ozaki

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Hidehisa Mori

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Kunihisa Yamaguchi

Department of Urology, Institute of Biomedical Sciences, Tokushima University Graduate School
Tokushima, Tokushima, Japan

Tomoharu Fukumori

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Masayuki Takahashi

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Hiro-omi Kanayama

The Department of Urology, Institute of Biomedical Sciences, Tokushima University graduate school
Tokushima, Tokushima, Japan

Masayoshi Nomura

Urogynecology Center, Kameda Medical Center
Kamogawa, Chiba, Japan