CEVL training for coronal/distal shaft hypospadias repair: a guide for attendings, residents, and OR staff

Surgical simulation of hypospadias repair - High-fidelity, reproducible and affordable animal tissue model

INTRODUCTION

Teaching methods in hypospadias repair are still traditional. Available simulators often lack authenticity in terms of haptic feedback and realistic tissue handling.

OBJECTIVE

Our aim was to develop a high-fidelity, easily reproducible, and affordable animal tissue model for the advanced surgical simulation of hypospadias repair with realistic haptic feedback and tissue handling.

MATERIAL AND METHODS

A regular-sized chicken leg and a lamb tenderloin are used to assess the feasibility of simulating hypospadias correction by using the example of a Snodgrass Tubularized Incised Plate-Repair. The model preparation is incorporated into the training process.

RESULTS

A detailed description of the high-fidelity model is provided. All steps of a hypospadias repair can be trained while providing realistic anatomy, adequate size, and multilayer tissue properties. Haptic conditions highly resemble human tissue properties. Fine tissue handling corresponds to intraoperative conditions. Limitations to this surgical model apply as in other animal tissue models.

CONCLUSION

We developed a high-fidelity, easily reproducible, and affordable hypospadias animal tissue model. Due to the multilayer animal tissue properties, this model provides realistic haptic feedback and thus an inexpensive and reproducible model for hypospadias simulation. External validation is mandatory prior to implementation into urological training.

Assessment of the Educational Value of Distal Hypospadias Repair Videos on YouTube

OBJECTIVE

To evaluate the quality of YouTube videos depicting distal hypospadias repair.

METHODS

The search terms "distal hypospadias repair" were used to identify surgical videos on YouTube. Videos were sorted by view count and the top 34 videos were reviewed for baseline video characteristics, key surgical steps covered, and conformity to a modified LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) checklist. All videos were reviewed and discussed for conformity by 2 attending pediatric urologists and a urology resident.

RESULTS

Of the 34 videos reviewed, 16 videos were excluded due to content. The median length of videos was 9.94 minutes (range, 2.57-99.12 minutes). Video quality was deemed of high quality in only 39% of videos. The most common type of hypospadias procedures described were tubularized incised plate urethroplasty (n = 13) and meatal advancement and glanuloplasty incorporated (n = 2). The median view count was 7828.5 (range, 1,133-58,619 views). Only 1 video met all modified LAP-VEGaS criteria (range of 33%-100%), and only 2 videos showed every surgical step of distal hypospadias repair (range 33%-100%). Modified LAP-VEGaS score, surgical step score, or quality of the video was not associated with a higher view count.

CONCLUSION

Despite being a common procedure, there is a paucity of high-quality videos on YouTube describing distal hypospadias repair techniques. It is unclear how learners select videos for study purposes and the most utilized videos on YouTube are not the most educational videos.

CEVL e-learning teaches GUMS method to "score" hypospadias preoperatively and predict postoperative outcomes

INTRODUCTION

Pediatric urological surgeons recognize the importance of formalizing the assessment of outcomes after hypospadias repair. To this end, surgical outcomes may be predicted by correlation with a summative score of objective assessments (Likert 1-4) of each: glans size, urethra plate appearance, meatus position, and extent of shaft chordee (GUMS). The best surgical outcome will be found in cases with the lowest score (GUMS = 4) and the worst surgical outcome in cases with the highest score (GUMS = 16).

OBJECTIVE

We aimed to determine if e-learning is suitable for training of the GUMS method. We did this by re-formatting the GUMS method of assessment of the hypospadias penis into an e-learning platform. Re-formatting was done using the CEVL (Computer Enhanced Visual Learning) context.

METHODS

A total of 49 cases provided content for the following content groups: learn basics (4 cases), scoring samples (16 cases), learn by examples (4 cases), practice scoring (15 cases), and self-test (10 cases). The content was formatted, edited (Adobe), and imported for interactive use (Articulate Storyline). Various frequently asked questions on how to score are also presented.

RESULTS

The survey respondents were pediatric urology attendings or fellows (60%) or urology residents (40%). E-learning GUMS scoring was done under 40 min before completion of the survey. Over 80% of respondents agreed/strongly agreed with the utility of the CEVL platform for learning the method. Respondents assigned GUMS scores to the survey cases and, on average, agreed on exactly the same scores for each component 63% of the time. The respondents chose the consensus score, or the next most common consensus score, 90% of the time.

CONCLUSION

We show that CEVL e-learning is an effective tool, which requires a minimal time investment, for teaching GUMS scoring. We believe that e-learning is a good platform to promote uniform clinical practices in outcomes research and for resident training.