ArticleJournal of robotic surgery2026
Development and validation of a training model for bladder neck dissection using ex vivo human bladder specimens from radical cystectomies.
Article in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
To develop and validate a simulation training model for bladder neck dissection (BND) during laparoscopic radical prostatectomy using ex vivo human bladder specimens obtained from patients who underwent radical cystectomy. Six novices laparoscopic surgeons (without laparoscopic radical prostatectomy [LRP] experience) and four urological specialists (who had completed at least 100 LRP cases) completed BND training four times. Training included exposure of the bladder neck, dissection of the anterior bladder muscle and mucosa, dissection of the posterior bladder mucosa, and separation of the seminal vesicle (SV). Construct validity was assessed using the completion time, pathological score, BND score, and SV score. Repeated measures analysis of variance was used to assess the learning curve. Face and content validity was evaluated using a closed questionnaire survey. The novice and expert groups showed significant differences in the completion times (15.21 ± 2.42 vs. 12.11 ± 2.05 min, p < 0.0001), total pathological scores (9.1 ± 3.3 vs. 12.9 ± 3.0, p = 0.001), BND scores (2.9 ± 0.9 vs. 4.1 ± 0.7, p < 0.001), and SV scores (2.9 ± 1.1 vs. 3.9 ± 0.7, p = 0.003). Between-subjects effects revealed a significant main effect of group (𝐹 = 24.029, p = 0.001, 𝜂2p = 0.750), with the expert group completion time significantly faster than the novice group across all time points. Within-subjects effects showed significant main effect of time (F = 150.594, p < 0.001, 𝜂2p = 0.950), indicating that completion time change significantly over the four measurements. The time × group interaction was not significant (F = 0.475, p = 0.703, 𝜂2𝑝 = 0.056), suggesting that the two groups followed similar trajectories over time. Between-subjects effects revealed a significant main effect of group (𝐹 = 7.414, p = 0.026, 𝜂2p = 0.481), with the expert group total pathological scores significantly higher than the novice group across all time points. Within-subjects effects showed no significant main effect of time (F = 0.964, p = 0.367, 𝜂2p = 0.108), indicating that scores did not change significantly over the four measurements. The time × group interaction was also not significant (F = 1.017, p = 0.353, 𝜂2𝑝 = 0.113), suggesting that the two groups followed similar trajectories over time. Furthermore, the model received positive feedback regarding realism and practicability (face and content validity). Developed and validated a simulation training model based on tissue-based prostatectomy simulation models for BND during laparoscopic radical prostatectomy. Ex vivo bladder specimens provide a practical option for simulation training. This model reduced surgical times and prevented excessive or inadequate tissue removal, thereby improving BND performance.
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