New Porcine Model for Training for Laparoscopic Ureteral Reimplantation with Horn of Uterus to Mimic Enlarged Ureter

Purpose: To develop a new porcine model with horn of the uterus to mimic an enlarged ureter for training for laparoscopic ureteral reimplantation (LUR) and to evaluate its feasibility. Materials and Methods: Ten female pigs were used in the training. The pig was placed to a dorsal position after an anesthetic was administered. The horn of the uterus near the bladder was dissected, then spatulated and trimmed to replace the enlarged ureter. LUR was performed according to standard operation steps. Four trainees completed the LUR procedure based on a mentor-trainee model to guarantee the success of the procedure and the quality of the anastomoses. The learning curve of operative time was analyzed. The anastomotic stoma was cut off postoperatively and checked extracorporeally. After the course, questionnaire surveys were sent to the trainees to investigate satisfaction of the training and assess the impact of the training on their learning of "real'' LUR in future practice. Results: This model reproduced the key technique steps of LUR. Four LUR procedures were performed on each pig. The operative time declined from 170.0 +/- 10.3 minutes to 90.3 +/- 3.7 minutes (P < 0.01) after the trainees had performed 10 LURs. There was proper stitching in each "ureterovesical'' anastomosis. At the end of training, all trainees could accomplish a LUR procedure skillfully on the model; they were satisfied after the course and thought the training was helpful to future practice of LUR. Conclusion: The new model was feasible and cost-effective for training in the basic skills of laparoscopic ureteral reconstruction procedures.