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Endoscopic Surgery: A New Teaching Method
0022-5347 /81/1262-0192$02.00/0 Vol. 126, August
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright© 1981 by The Williams & Wilkins Co.
ENDOSCOPIC SURGERY: A NEW TEACHING METHOD JOSE C. S. TRINDADE, MILTON F. M. LAUTENSCHLAGER
AND
CARLOS GOMES
DE
ARAUJO
From the Department of Urology, University of California School of Medicine, San Francisco, California, and Faculdade de Medicina de Botucatu, Botucatu, Brazil
ABSTRACT
A new method of teaching endoscopic surgery with a canine model is described. Its main advantage over the few existing methods is that it best reproduces the events of the human transurethral resection. Endoscopic surgery is primordial in the practice of urology. For that reason it is essential that it be taught by the best methods. Everyone who has the responsibility of teaching transurethral surgery knows that it is a long and arduous path before the resident becomes familiar with the technique of electrosurgery and confident with the operative field. Only a few teaching methods of transurethral resection have been reported. Essentially, they are based on the use of human cadaver organs, such as the bladder and prostate; 1- 3 animal organs, such as the cow udder;4 or even artificial sets, such as the wax prostate and bladder proposed by Baumrucker. 5 Endoscopic surgery also has been taught with the help of double prism eyepieces attached to the instructor's cystoscope. These methods have their individual advantages and limitations. However, the feature common to all is the fact that none can reproduce most of the events that take place in human transurethral resection and this may be the reason they have not achieved popularity.
is positioned as shown in the figure. A catheter is placed in the urethra and a perinea! urethrostomy is done at the level of the bulbar urethra. Hemostasis is achieved best by putting a running suture in the edges of the open urethra. After these edges are sutured to the skin and before the cystoscope or resectoscope is introduced it is advisable to dilate the proximal urethra with straight metal sounds. This single animal procedure offers the beginner the opportunity of recognizing in vivo the anatomical landmarks necessary for cystoscopic examination or for transurethral resection, and to practice transurethral resection of the prostate with almost all its inherent events. In addition, training can be improved by provoking various accidents in the animal model, such as gross bleeding and perforations of the bladder, bladder neck and prostatic capsule. This model also can be used to study some of the local and systemic effects of transurethral resection of the prostate, with or without complications. We believe that this method has a
Position of dog for transurethral resection of prostate
In an effort to teach transurethral resection without submitting patients to neophytes we conceived a canine model closely approximating the situation of human transurethral resection of the prostate. We have found our procedure useful for beginners in becoming familiar with the instruments, in learning cutting and coagulating, and in recognizing tissues and anatomical landmarks. ANIMAL MODEL
The older the dog the greater the chance to find an enlarged prostate, which is a desirable feature. After conventional anesthesia (30 mg./kg. body weight sodium pentobarbital) the dog Accepted for publication October 31, 1980. Requests for reprints: Urology, M-553, University of California, San Francisco, California 94143.
192
number of advantages over those previously mentioned. In our hands, it has been a useful instrument to teach transurethral resection of the prostate to urology residents. REFERENCES
1. Cervantes, L. and Keitzer, W. A.: Endoscopic training in urology. J.
Ural., 84: 585, 1960. 2. Fiddian, R. V.: A method of training in periurethral resection. Brit. J. Ural., 39: 192, 1967. 3. Narwani, K. P. and Reid, E. C.: Teaching transurethral prostatic resection using cadaver bladder. J. Urol., 101: 101, 1969. 4. Habib, H. N., Berger, J. and Winter, C. C.: Teaching transurethral surgery using a cow's udder. J. Ural., 93: 77, 1965. 5. Baumrucker, G. 0.: TUR-Transurethral Prostatectomy: Technique, Hazards, and Pitfalls. Baltimore: The Williams & Wilkins Co., p. 15, 1969.
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright© 1981 by The Williams & Wilkins Co.
ENDOSCOPIC SURGERY: A NEW TEACHING METHOD JOSE C. S. TRINDADE, MILTON F. M. LAUTENSCHLAGER
AND
CARLOS GOMES
DE
ARAUJO
From the Department of Urology, University of California School of Medicine, San Francisco, California, and Faculdade de Medicina de Botucatu, Botucatu, Brazil
ABSTRACT
A new method of teaching endoscopic surgery with a canine model is described. Its main advantage over the few existing methods is that it best reproduces the events of the human transurethral resection. Endoscopic surgery is primordial in the practice of urology. For that reason it is essential that it be taught by the best methods. Everyone who has the responsibility of teaching transurethral surgery knows that it is a long and arduous path before the resident becomes familiar with the technique of electrosurgery and confident with the operative field. Only a few teaching methods of transurethral resection have been reported. Essentially, they are based on the use of human cadaver organs, such as the bladder and prostate; 1- 3 animal organs, such as the cow udder;4 or even artificial sets, such as the wax prostate and bladder proposed by Baumrucker. 5 Endoscopic surgery also has been taught with the help of double prism eyepieces attached to the instructor's cystoscope. These methods have their individual advantages and limitations. However, the feature common to all is the fact that none can reproduce most of the events that take place in human transurethral resection and this may be the reason they have not achieved popularity.
is positioned as shown in the figure. A catheter is placed in the urethra and a perinea! urethrostomy is done at the level of the bulbar urethra. Hemostasis is achieved best by putting a running suture in the edges of the open urethra. After these edges are sutured to the skin and before the cystoscope or resectoscope is introduced it is advisable to dilate the proximal urethra with straight metal sounds. This single animal procedure offers the beginner the opportunity of recognizing in vivo the anatomical landmarks necessary for cystoscopic examination or for transurethral resection, and to practice transurethral resection of the prostate with almost all its inherent events. In addition, training can be improved by provoking various accidents in the animal model, such as gross bleeding and perforations of the bladder, bladder neck and prostatic capsule. This model also can be used to study some of the local and systemic effects of transurethral resection of the prostate, with or without complications. We believe that this method has a
Position of dog for transurethral resection of prostate
In an effort to teach transurethral resection without submitting patients to neophytes we conceived a canine model closely approximating the situation of human transurethral resection of the prostate. We have found our procedure useful for beginners in becoming familiar with the instruments, in learning cutting and coagulating, and in recognizing tissues and anatomical landmarks. ANIMAL MODEL
The older the dog the greater the chance to find an enlarged prostate, which is a desirable feature. After conventional anesthesia (30 mg./kg. body weight sodium pentobarbital) the dog Accepted for publication October 31, 1980. Requests for reprints: Urology, M-553, University of California, San Francisco, California 94143.
192
number of advantages over those previously mentioned. In our hands, it has been a useful instrument to teach transurethral resection of the prostate to urology residents. REFERENCES
1. Cervantes, L. and Keitzer, W. A.: Endoscopic training in urology. J.
Ural., 84: 585, 1960. 2. Fiddian, R. V.: A method of training in periurethral resection. Brit. J. Ural., 39: 192, 1967. 3. Narwani, K. P. and Reid, E. C.: Teaching transurethral prostatic resection using cadaver bladder. J. Urol., 101: 101, 1969. 4. Habib, H. N., Berger, J. and Winter, C. C.: Teaching transurethral surgery using a cow's udder. J. Ural., 93: 77, 1965. 5. Baumrucker, G. 0.: TUR-Transurethral Prostatectomy: Technique, Hazards, and Pitfalls. Baltimore: The Williams & Wilkins Co., p. 15, 1969.