455sutures on both the low-fidelity model and the foam pad. The study found that the
intervention group scored significantly higher on a task-specific checklist (10.9 vs 8.1,
p = 0.017) and global rating score (29.6 vs 22.8, p = 0.005) and in significantly less
time (27.6 vs 38.3 min, p = 0.004) compared to the control group [ 61 ]. The authors
subsequently published a prospective, single-blind, randomized study of their model
in which the same cohort of 28 participants was again divided into the same interven-
tion and control groups, but this time, the participants were evaluated on their ability
to do a UVA on an anesthetized pig. Again, the group that trained on the low-fidelity
model did significantly better than the control group in terms of checklist score, global
rating score, and end product rating, demonstrating that skills acquired in a low-
fidelity trainer can be translated to more “real-life” situations [ 62 ].
The third bench model is a combination bench-and-animal model simulating
UVA, which has been proposed by Laguna et al. [ 63 ]. The authors used dead,
plucked chickens that were at least 2.5 kilograms for their simulation. Using two
subcostal incisions extended to the thighs, the authors removed all thoracoabdomi-
nal organs except for the esophagus and the stomach. An 18F catheter was placed
through the esophagus, and the chicken was then placed within a Pelvic Trainer
through which a standard laparoscopic camera and instruments could be used. Once
in the box trainer, the specimen was transected completely at the gastroesophageal
junction. In their study of the model, five urologists of varying experience (ranging
from never having done a laparoscopic radical prostatectomy to >250 performed)
were instructed to sew the UVA with two different suturing methods (six interrupted
sutures vs running single-knot suture). The study found that suturing time and oper-
ator experience were linearly related (r = −0.724, p < 0.001) and that the most
inexperienced surgeon significantly reduced the time required to complete the anas-
tomosis with interrupted sutures (320.5 vs 146.7 s per stitch, p = 0.001) [ 63 ].
Female Urology
Sacrocolpopexy
Commonly performed by urologists with a focus in female urology, sacrocolpopexy
is considered by many to be the “gold standard” procedure to repair vaginal pro-
lapse. Sacrocolpopexy can be performed open, laparoscopically, or robotically, but
as with many other surgeries, there is an increasing trend to perform this procedure
more often in a minimally invasive fashion. However, with minimally invasive sur-
gery comes with the added difficulty of laparoscopic suturing. Therefore, a model
for laparoscopic sacrocolpopexy was created. Tunitsky-Bitton et al. created a sim-
ple bench model for laparoscopic sacrocolpopexy in which a RUMI Advanced
Uterine Manipulation System (Cooper Surgical, Inc., Trumbull, CT) with attached
sacrocolpopexy tip was covered with swimsuit material and placed within a stan-
dard FLS box trainer [ 64 ]. The authors studied this model with 5 experts (female
pelvic medicine and reconstructive surgeons experienced with laparoscopic sacro-
colpopexy) and 15 trainee participants (fourth-year gynecology residents and fel-
lows). Participants used the model to perform the most difficult step of the
24 Simulation in Surgery