Construct validity of the pig intestine model in the simulation of laparoscopic urethrovesical anastomosis: Tools for objective evaluation

Purpose: We examined the construct validity of a porcine-intestine model for ultimately performing a laparoscopic urethrovesical anastomosis. Materials and Methods: Pig intestine was used to create a model for laparoscopic urethrovesical anastomosis (L-UVA) performed laparoscopically in the LapTrainer™. Twelve subjects (residents and medical students) with different levels of experience in laparoscopy were divided into three groups depending on their previous level of training with the laparoscope and with robot-assisted laparoscopic prostatectomy (RALP). Each subject performed a running laparoscopic anastomosis of pig intestine in the box trainer. Performance time and volume of leak from the anastomosis were recorded. Results: Those in the most experienced group completed the anastomosis in an average of 34.30 min. Those in the less experienced group averaged 67.13 min, and those in the group with no experience averaged 114.72 min. The difference between the groups was significant with one-way analysis of variance (ANOVA) (P < 0.0001). Those in the most experienced group averaged 2.64 mL of leakage from the anastomosis; the less experienced subjects averaged 9.98 mL, and those in the group with no experience averaged 26.38 mL. The difference between the groups was significant with one-way ANOVA (P = 0.0005). Conclusion: Tests of performance time and postoperative leakage accurately reflected the subjects' degree of experience, indicating that this model for L-UVA provides an experience closely resembling the person's past experience and that the porcine intestine provides a valid model for simulating the procedure. Measuring volume of leakage from the anastomosis provides an objective measure of the quality of the anastomosis.