(261) Vasovasostomy Surgical Simulation Using En Bloc Orchiectomy Specimen
Authors: Masterson J , Huynh C , Sandhu S , Smith S , Moradzadeh A , Kim H , Garcia M 
Published: February 2024

Abstract

Introduction
Surgical simulation with use of synthetic materials, animals, or human tissues is an essential part of surgical training. Prior vasovasostomy (VV) simulations have described use of silicone tubules, animal vasa, and vas segments from human prostatectomy specimen. Herein we describe a VV surgical simulation model using benign, en bloc human testicle and spermatic cord specimen acquired via gender-affirming simple orchiectomy.

Objective
To improve resident confidence in performing VV via a surgical wet lab using benign, en bloc human testicle and spermatic cord specimen acquired via gender-affirming simple orchiectomy.

Methods
En bloc testicle and spermatic cord specimen from benign orchiectomy procedures were stored in our institution’s tissue bank. After development of a tissue handling protocol, specimens were then transported to our surgical simulation center for use in a VV microsurgical surgical simulation exercise. Participants were asked to complete a six-throw VV anastomosis using specimen. The first three throws were “training naïve,” with no prior instruction and an 8-minute time cap. After the first three throws or 8 minutes of time, participants received 10 minutes of hands-on instruction from a fellowship-trained urologic microsurgeon, then completed the remaining three throws of their six-throw anastomosis. Performance was measured using a microsurgical skills assessment tool for each set of three stitches and compared (figure 1). Pre- exercise and post- exercise surveys (figure 2) were completed in which participants rated their confidence in performing VV. Two months later, the same participants returned for an interval skills assessment in which they were tasked with completing the six-throw anastomosis in a 16-minute time limit. Skills were again evaluated with the microsurgical skills assessment tool; pre- and post- exercise surveys were again completed.

Results
Four urology trainees participated in our exercise: two PGY2s, one PGY3 and one PGY4. Completed number of knots increased from the first 8-minute session to the final 8-minute session for all participants (table 1). Surgical performance as measured by the skills-assessment tool did not change as a result of the instruction intervention (table 1). Participant confidence in performing microsurgical VV improved between the pre- and post- exercise surveys (table 2). All participants felt the wet lab served as a realistic representation of real-life VV (table 3)). At the two-month reassessment time point, all participants completed a similar number of throws (+/- 1 throw) in an overall equal amount of time (16 consecutive minutes compared to 8 minutes twice) with similar surgical performance compared to initial assessment (table 4).

Conclusions
A microsurgical VV wet lab using en bloc benign orchiectomy specimen serves a realistic simulation of real-life VV and improves trainee confidence in performing this procedure. Real-time instruction likely provides less value for improving operative skill than does experience and repetitions alone. These findings support not only the use of human specimen for surgical training, but also the value of a gender-affirming surgery program which provides access to these benign specimens.

Disclosure
No.