Development and face validity testing of pyeloplasty surgical training models.

Abstract

Background: There are few realistic and accessible laparoscopic pyeloplasty training models. The aim of this study is to develop a functional training model through user-centered design that depicts the pathological features of pelvicoureteric junction obstruction (PUJO).

Methods: Realistic patient-matched anatomical models of the kidney, renal pelvis, and ureter were created based on segmentations of computed tomography (CT) scans of a paediatric patient with PUJO who underwent laparoscopic pyeloplasty. Three training model versions (polyjet, resin, and silicone) were produced, tested, and published. Training model testing was conducted by consultant surgeons (n = 14), training surgeons (n = 5), and medical students (n = 8). Face validity testing was conducted to assess realism and usefulness of training models on a 10-point Likert-type scale. Training model accessibility was assessed using equipment availability and cost to set-up and produce as proxy measures.

Results: Participants significantly preferred polyjet and silicone models over resin models for overall rating (6.9 ± 2.3, 7.9 ± 1.1, and 5.0 ± 1.8) respectively; and usefulness in trainees (7.6 ± 2.1, 8.6 ± 0.9, and 5.0 ± 3.1) respectively. While both the polyjet and silicone models were found to be realistic and useful, the silicone model is considered more accessible due to the ready availability of the manufacturing equipment and materials and around 300-fold reduction in cost compared to polyjet.

Conclusions: A surgeon-assessed realistic and useful pyeloplasty surgical training model was developed here which enables surgical practice on challenging small anatomical features. The comparatively low cost and accessibility of the silicone model can enable trainees to practice the procedure depicting the realistic pathological features in environments with limited resources.