madman
Super Moderator
ABSTRACT
Introduction: Plaque incision and graft (PIG) is suggested for the treatment of significant Peyronie’s disease (PD), but most surgeons perform very few PIG surgeries annually, and the number of PD cases requiring PIG is inadequate to maintain the necessary skills and completely master the procedure.
Aim: To develop and validate a new 3D-printed model of a curved penis and graft to simulate PIG surgery. This is the first PIG surgical training simulator described in the medical literature.
Methods: A 3D-printed model of the corpora cavernosa with a 60-degree curvature and an associated urethra was created using a flexible filament of thermoplastic polyurethane. Twenty-two urologists from Brazil were recruited to perform simulated surgery on the 3D model. The participants included 12 senior-level and 10 trainee-level urologists.
Main outcome measures: Evaluation of the device was based on a 15-item questionnaire using a 5-point Likert-type scale for each item.
Results: Each participant performed one simulated surgery with the 3D-printed model. All participants agreed that the simulation should be implemented into training programs. Participants ranked all content validity components 4.41 and all face validity components 3.83. The mean usability score was 4.25, and the overall experience scores were 4.75 (senior) and 5.0 (trainee).
Conclusion: Senior and trainee urologists evaluated this first reported simulated PIG training model for penile curvature correction as an acceptable tool for training and maintaining necessary PIG skills. This model may improve PIG training and surgeon skill, thereby improving patient safety and outcomes.
INTRODUCTION
Peyronie’s disease (PD) can appear as a variety of penile deformities that can generate an impairment or inability to achieve adequate sexual intercourse. The reported prevalence rates of PD vary from 3% to 8.9%, with >75% of cases occurring in men aged 45-65 years, and 10% of patients experiencing symptoms before 40 years of age.1 Furthermore, the incidence of PD after radical prostatectomy is reported to be as high as 15.9%, and a recent study showed that penile curvature is a common finding (38.6%) during inflatable penile prosthesis implantation surgery for erectile dysfunction (ED) after prostate cancer treatment.2
Patients presenting with severe loss of penile length, significant or severe curvature, and/or prominent hourglass deformities but without underlying ED are best treated by plaque incision and graft (PIG).1 Regardless of this recommendation, in a recent survey with members of several sexual medicine societies, Chung et al3 reported that most surgeons (>80%) performed less than 10 cases of PD graft surgery in a year and there was no significant difference observed across the principal urological and sexual medicine societies. Only 3-6% of these surgeons performed >20 PIGs in a year. Another survey showed that only 37% of urologists perform any PIG surgeries.4 Therefore, there are insufficient PD cases to maintain the necessary skills and completely master the PIG procedure.
The aim of this work was to determine whether the training of novice surgeons and maintenance of the skills of more expert surgeons could be accomplished at low costs and without the associated patient risks. For this purpose, a new simulator of a curved penis was created using a 3D printer with flexible material to simulate PIG surgery. While other researchers have created similar surgical simulators using 3D technology for training in penile prosthesis implants.5,6 This is the first attempt at creating a surgical simulator for PIG described in the medical literature.
*The 3D-printing technology brings infinite possibilities in the reconstruction of the human anatomy. It is possible to use computer tomography or magnetic resonance imaging to recreate the patient’s body segment to simulate surgery. Alternatively, we can design a template similar to the body part to construct a 3D simulation, as we did here. This technology’s limitation is the inability to model structures with less than 1 mm, making it impossible to reproduce human microanatomy. This limit in printing resolution does not allow the production of structures like the deferent duct. Therefore, it is not possible to construct, for example, a vasectomy reversion simulator. Nevertheless, we can recreate penile anatomy to simulate a penile prosthesis implant, penile plication, and other structures of size more than 1 mm.
CONCLUSION
This is the first reported simulated model to train surgeons to perform PIG to correct penile curvature. The model is inexpensive and received high marks from both trainees and expert surgeons for usability and realism. It may improve PIG training and surgeon skill, thereby improving patient safety and outcomes. The model could be a valuable addition to training programs and may also be used to develop new surgical techniques and tools to correct the penile deformity.
Introduction: Plaque incision and graft (PIG) is suggested for the treatment of significant Peyronie’s disease (PD), but most surgeons perform very few PIG surgeries annually, and the number of PD cases requiring PIG is inadequate to maintain the necessary skills and completely master the procedure.
Aim: To develop and validate a new 3D-printed model of a curved penis and graft to simulate PIG surgery. This is the first PIG surgical training simulator described in the medical literature.
Methods: A 3D-printed model of the corpora cavernosa with a 60-degree curvature and an associated urethra was created using a flexible filament of thermoplastic polyurethane. Twenty-two urologists from Brazil were recruited to perform simulated surgery on the 3D model. The participants included 12 senior-level and 10 trainee-level urologists.
Main outcome measures: Evaluation of the device was based on a 15-item questionnaire using a 5-point Likert-type scale for each item.
Results: Each participant performed one simulated surgery with the 3D-printed model. All participants agreed that the simulation should be implemented into training programs. Participants ranked all content validity components 4.41 and all face validity components 3.83. The mean usability score was 4.25, and the overall experience scores were 4.75 (senior) and 5.0 (trainee).
Conclusion: Senior and trainee urologists evaluated this first reported simulated PIG training model for penile curvature correction as an acceptable tool for training and maintaining necessary PIG skills. This model may improve PIG training and surgeon skill, thereby improving patient safety and outcomes.
INTRODUCTION
Peyronie’s disease (PD) can appear as a variety of penile deformities that can generate an impairment or inability to achieve adequate sexual intercourse. The reported prevalence rates of PD vary from 3% to 8.9%, with >75% of cases occurring in men aged 45-65 years, and 10% of patients experiencing symptoms before 40 years of age.1 Furthermore, the incidence of PD after radical prostatectomy is reported to be as high as 15.9%, and a recent study showed that penile curvature is a common finding (38.6%) during inflatable penile prosthesis implantation surgery for erectile dysfunction (ED) after prostate cancer treatment.2
Patients presenting with severe loss of penile length, significant or severe curvature, and/or prominent hourglass deformities but without underlying ED are best treated by plaque incision and graft (PIG).1 Regardless of this recommendation, in a recent survey with members of several sexual medicine societies, Chung et al3 reported that most surgeons (>80%) performed less than 10 cases of PD graft surgery in a year and there was no significant difference observed across the principal urological and sexual medicine societies. Only 3-6% of these surgeons performed >20 PIGs in a year. Another survey showed that only 37% of urologists perform any PIG surgeries.4 Therefore, there are insufficient PD cases to maintain the necessary skills and completely master the PIG procedure.
The aim of this work was to determine whether the training of novice surgeons and maintenance of the skills of more expert surgeons could be accomplished at low costs and without the associated patient risks. For this purpose, a new simulator of a curved penis was created using a 3D printer with flexible material to simulate PIG surgery. While other researchers have created similar surgical simulators using 3D technology for training in penile prosthesis implants.5,6 This is the first attempt at creating a surgical simulator for PIG described in the medical literature.
*The 3D-printing technology brings infinite possibilities in the reconstruction of the human anatomy. It is possible to use computer tomography or magnetic resonance imaging to recreate the patient’s body segment to simulate surgery. Alternatively, we can design a template similar to the body part to construct a 3D simulation, as we did here. This technology’s limitation is the inability to model structures with less than 1 mm, making it impossible to reproduce human microanatomy. This limit in printing resolution does not allow the production of structures like the deferent duct. Therefore, it is not possible to construct, for example, a vasectomy reversion simulator. Nevertheless, we can recreate penile anatomy to simulate a penile prosthesis implant, penile plication, and other structures of size more than 1 mm.
CONCLUSION
This is the first reported simulated model to train surgeons to perform PIG to correct penile curvature. The model is inexpensive and received high marks from both trainees and expert surgeons for usability and realism. It may improve PIG training and surgeon skill, thereby improving patient safety and outcomes. The model could be a valuable addition to training programs and may also be used to develop new surgical techniques and tools to correct the penile deformity.
