Top

World Journal of Urology

Published in:

01-05-2019 | Original Article

Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy

Authors: Emma Clarebrough, Daniel Christidis, Uri Lindner, Kimberly Fernandes, Neil Fleshner, Nathan Lawrentschuk

Published in: World Journal of Urology | Issue 5/2019

Abstract

Purpose

With the rapidly expanding anatomical and technical knowledge surrounding nervesparing radical prostatectomy (NSRP), anatomical and operative textbooks have failed to keep pace with the literature. A surgical skill laboratory (SSL) was designed to educate urology trainees on surgical anatomy and techniques for NSRP. The objective was to assess the validity of a SSL program.

Methods

A low-fidelity, anatomically accurate prostate model with its appropriate fascial coverings and location of the neurovascular bundle was created. Participants were surveyed prior to a SSL workshop for their knowledge of NSRP focusing on clinical and anatomical considerations. An interactive 2-h tutorial and workshop was then undertaken outlining the clinical and anatomical nuances for NSRP, with participants then practising an intra and inter-fascial NSRP on the model. Participants were resurveyed immediately after the workshop and at 6 months.

Results

Thirty participants completed the NSRP workshop. Significant differences (p < 0.0001) in anatomical and clinical knowledge were noted after the workshop with improvements for both junior and senior trainees. The knowledge was retained at 6 months following the workshop.

Conclusions

A low-fidelity bench-top model is a feasible and reproducible technique for improving the understanding of periprostatic anatomy and the different surgical approaches for NSRP. The SSL is useful and knowledge gained appears to be retained by workshop participants. SSL workshops are a valid hands-on approach to teaching surgical skills and should remain an integral part of urology training.

Walsh PC, Donker PJ (1982) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128(3):492–497CrossRef

Tewari A, Peabody JO, Fischer M, Sarle R, Vallancien G, Delmas V, Hassan M, Bansal A, Hemal AK, Guillonneau B, Menon M (2003) An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol 43(5):444–454. https://doi.org/10.1016/S0302-2838(03)00093-9 CrossRefPubMed

Clarebrough EE, Challacombe BJ, Briggs C, Namdarian B, Weston R, Murphy DG, Costello AJ (2011) Cadaveric analysis of periprostatic nerve distribution: an anatomical basis for high anterior release during radical prostatectomy? J Urol 185(4):1519–1525. https://doi.org/10.1016/j.juro.2010.11.046 CrossRefPubMed

Costello AJ, Brooks M, Cole OJ (2004) Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int 94(7):1071–1076. https://doi.org/10.1111/j.1464-410x.2004.05106.x CrossRefPubMed

Takenaka A, Kawada M, Murakami G, Hisasue S, Tsukamoto T, Fujisawa M (2005) Interindividual variation in distribution of extramural ganglion cells in the male pelvis: a semi-quantitative and immunohistochemical study concerning nerve-sparing pelvic surgery. Eur Urol 48(1):46–52. https://doi.org/10.1016/j.eururo.2005.02.010 (discussion 52) CrossRefPubMed

Eichelberg C, Erbersdobler A, Michl U, Schlomm T, Salomon G, Graefen M, Huland H (2007) Nerve distribution along the prostatic capsule. Eur Urol 51(1):105–110. https://doi.org/10.1016/j.eururo.2006.05.038 (discussion 110–101) CrossRefPubMed

Tewari A, Takenaka A, Mtui E, Horninger W, Peschel R, Bartsch G, Vaughan ED (2006) The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve-sparing prostatectomy. BJU Int 98(2):314–323. https://doi.org/10.1111/j.1464-410x.2006.06266.x CrossRefPubMed

Ayala AG, Ro JY, Babaian R, Troncoso P, Grignon DJ (1989) The prostatic capsule: does it exist? Its importance in the staging and treatment of prostatic carcinoma. Am J Surg Pathol 13(1):21–27CrossRef

Kourambas J, Angus DG, Hosking P, Chou ST (1998) A histological study of Denonvilliers’ fascia and its relationship to the neurovascular bundle. Br J Urol 82(3):408–410CrossRef

10.

Chuang AY, Epstein JI (2008) Positive surgical margins in areas of capsular incision in otherwise organ-confined disease at radical prostatectomy: histologic features and pitfalls. Am J Surg Pathol 32(8):1201–1206. https://doi.org/10.1097/pas.0b013e318162a8bf CrossRefPubMed

11.

Rassweiler J (2006) Intrafascial nerve-sparing laproscopic radical prostatectomy: do we really preserve relevant nerve-fibres? Eur Urol 49(6):955–957. https://doi.org/10.1016/j.eururo.2006.03.053 CrossRefPubMed

12.

Walz J, Graefen M, Huland H (2011) Surgical anatomy of the prostate in the era of radical robotic prostatectomy. Curr Opin Urol 21(3):173–178. https://doi.org/10.1097/mou.0b013e3283449d6d CrossRefPubMed

13.

Stolzenburg JU, Rabenalt R, Do M, Tannapfel A, Truss MC, Liatsikos EN (2006) Nerve-sparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique. J Endourol 20(11):925–929. https://doi.org/10.1089/end.2006.20.925 CrossRefPubMed

14.

Chabert CC, Merrilees DA, Neill MG, Eden CG (2008) Curtain dissection of the lateral prostatic fascia and potency after laparoscopic radical prostatectomy: a veil of mystery. BJU Int 101(10):1285–1288. https://doi.org/10.1111/j.1464-410x.2008.07595.x CrossRefPubMed

15.

Kaul S, Savera A, Badani K, Fumo M, Bhandari A, Menon M (2006) Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int 97(3):467–472. https://doi.org/10.1111/j.1464-410x.2006.05990.x CrossRefPubMed

16.

Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM (2010) A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 58(3):457–461. https://doi.org/10.1016/j.eururo.2010.06.008 CrossRefPubMed

17.

Barre C (2007) Open radical retropubic prostatectomy. Eur Urol 52(1):71–80. https://doi.org/10.1016/j.eururo.2006.11.057 CrossRefPubMed

18.

Lawrentschuk N, Lindner U (2011) Realistic anatomical prostate models for surgical skills workshops: nerve-sparing radical prostatectomy and simple prostatectomy. Korean J Urol 52(2):130–135. https://doi.org/10.4111/kju.2011.52.2.130 CrossRefPubMedPubMedCentral

19.

McNeal JE (1981) The zonal anatomy of the prostate. Prostate 2(1):35–49CrossRef

20.

Montorsi F, Brock G, Lee J, Shapiro J, Van Poppel H, Graefen M, Stief C (2008) Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve-sparing radical prostatectomy. Eur Urol 54(4):924–931. https://doi.org/10.1016/j.eururo.2008.06.083 CrossRefPubMed

21.

Sievert KD, Hennenlotter J, Laible I, Amend B, Schilling D, Anastasiadis A, Kuehs U, Nagele U, Stenzl A (2008) The periprostatic autonomic nerves–bundle or layer? Eur Urol 54(5):1109–1116. https://doi.org/10.1016/j.eururo.2008.06.007 CrossRefPubMed

22.

Sievert KD, Hennenlotter J, Laible IA, Amend B, Nagele U, Stenzl A (2009) The commonly performed nerve sparing total prostatectomy does not acknowledge the actual nerve courses. J Urol 181(3):1076–1081. https://doi.org/10.1016/j.juro.2008.10.154 CrossRefPubMed

23.

Walsh PC (2007) The discovery of the cavernous nerves and development of nerve sparing radical retropubic prostatectomy. J Urol 177(5):1632–1635. https://doi.org/10.1016/j.juro.2007.01.012 CrossRefPubMed

24.

Stolzenburg JU, Rabenalt R, Do M, Schwalenberg T, Winkler M, Dietel A, Liatsikos E (2008) Intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy. Eur Urol 53(5):931–940. https://doi.org/10.1016/j.eururo.2007.11.047 CrossRefPubMed

25.

Mattei A, Naspro R, Annino F, Burke D, Guida R Jr, Gaston R (2007) Tension and energy-free robotic-assisted laparoscopic radical prostatectomy with interfascial dissection of the neurovascular bundles. Eur Urol 52(3):687–694. https://doi.org/10.1016/j.eururo.2007.05.029 CrossRefPubMed

26.

Rassweiler J, Wagner AA, Moazin M, Gozen AS, Teber D, Frede T, Su LM (2006) Anatomic nerve-sparing laparoscopic radical prostatectomy: comparison of retrograde and antegrade techniques. Urology 68(3):587–591. https://doi.org/10.1016/j.urology.2006.03.082 (discussion 591–582) CrossRefPubMed

27.

Kneebone R, Apsimon D (2001) Surgical skills training: simulation and multimedia combined. Med Educ 35(9):909–915CrossRef

28.

Lawrentschuk N, Lindner U, Fleshner N (2009) Current textbooks and anatomy of the prostate—a case for an update. BJU Int 103(10):1319–1322. https://doi.org/10.1111/j.1464-410x.2009.08426.x CrossRefPubMed

29.

Moglia A, Ferrari V, Morelli L, Ferrari M, Mosca F, Cuschieri A (2016) A systematic review of virtual reality simulators for robot-assisted surgery. Eur Urol 69(6):1065–1080. https://doi.org/10.1016/j.eururo.2015.09.021 CrossRefPubMed

30.

Cheung CL, Looi T, Lendvay TS, Drake JM, Farhat WA (2014) Use of 3-dimensional printing technology and silicone modeling in surgical simulation: development and face validation in pediatric laparoscopic pyeloplasty. J Surg Educ 71(5):762–767. https://doi.org/10.1016/j.jsurg.2014.03.001 CrossRefPubMed

Title: Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy
Authors: Emma Clarebrough
Daniel Christidis
Uri Lindner
Kimberly Fernandes
Neil Fleshner
Nathan Lawrentschuk
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 5/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2472-7

At a glance: The STEP trials

Springer Medicine

Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2019

Thulium laser enucleation versus thulium laser resection of the prostate for prevention of bladder neck contracture in a small prostate: a prospective randomized trial

Long-term outcomes of ultrasound-guided percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience

The reporting quality of studies of diagnostic accuracy in the urologic literature

Ureteral wall thickness as a significant factor in predicting spontaneous passage of ureteral stones of ≤ 10 mm: a preliminary report

The relationship between body-mass index, physical activity, and pathologic and clinical outcomes after radical prostatectomy for prostate cancer

Modifications to Botulinum toxin A delivery in the management of detrusor overactivity recalcitrant to initial injections: a review