V10-11: A Live Porcine Model for Robotic Sacrocolpopexy Training
Over 200,000 surgeries are performed in the United States annually for correction of pelvic organ prolapse (POP). That figure is expected to increase 47.2% by 2050. Sacrocolpopexy is widely considered the gold standard prolapse surgery, and the robotic approach is the most widely used minimally invasive approach. The significant learning curve for the robotic sacrocolpopexy underscores the need to develop a realistic model for teaching this complex procedure. Given the cost and scarcity of human cadavers, the live porcine model represents a realistic, available, and cost-effective alternative. In this study, we created a porcine model for the robotic sacrocolpopexy and sought to determine its effectiveness as a teaching tool.
Under the permission of the Institutional Animal Care and Use Committee (IACUC) of the University of Houston (UH), we developed our model for robotic sacrocolpopexy using the domestic pig. All the surgeries were all performed under general anesthesia with monitoring under the advisement of the protocols established by UH. All operations were terminal. From December 2016 to October 2017, 20 surgeons attended the two-day sacrocolpopexy training module. All physicians were currently in practice and had variable levels of experience with this surgery. The first day consisted of didactics and the second was creation and use of the porcine model (13 pigs total used for all participants). A post-module survey was given to 20 participants at the completion of the course and 10 completed it.
Our porcine module consisted of two steps: (1) creating the porcine cervical model which mimics human tissue and (2) performing the simulated robotic sacrocolpopexy using the cervical model. The post-module survey showed that 100% of the participants reported improvements in their economy of motion, tissue handling ability, suturing efficiency and overall performance of the robotic sacrocolpopexy. Also, 100% of participants reported they were likely to incorporate aspects of the model into their practice and recommend the model to colleagues (90% very likely, 10% somewhat likely).
The porcine model provides a feasible and highly effective tool for teaching the robotic sacrocolpopexy to physicians. Utilizing this training module may help close the gap in the demand for this pelvic organ prolapse procedure and adequately trained practitioners who can perform it.