Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Surgery

Supervisor

Power, Nicholas E.

2nd Supervisor

Beveridge, Tyler S.

Co-Supervisor

3rd Supervisor

Huynh, Melissa

Co-Supervisor

Abstract

Nerve-sparing Retroperitoneal lymph node dissection (RPLND) is a complex and rare surgical procedure where trainees have limited exposure. We have created facilitator-led video learning material to teach this procedure. Ten urology trainees were tasked with performing one-half (unilateral portion) of a nerve-sparing RPLND on human cadavers before and after watching the video material. Their surgical performance was assessed quantitatively and video-recorded for further qualitative assessment by a blinded expert surgeon.

All measurements showed significant improvement after the exposure to the intervention. This included the percentage of lymph node mass resected, mean total OSATS global rating and procedure-specific scales as well as mean self-assessment scores. The results suggested that a significant amount of possible surgical performance improvement can come from the opportunity to participate in the video learning material and cadaveric simulation. We expect this model to be successfully applied to teaching complex and rare procedures in other fields as well.

Summary for Lay Audience

Surgical residency training requires not only theoretical knowledge but also technical skills. Recent global developments have impacted modern surgical residency programs and created new challenges to training highly skilled surgeons the world over. The effect of major events like the COVID-19 pandemic, along with changes in working hours and a reduction in operative exposure, continue to influence trainees’ ability to gain operative experience in many surgical procedures.

Retroperitoneal Lymph Node Dissection (RPLND) is a highly effective surgery to remove testicular cancer metastases with high cure rates in expert centers. However, RPLND poses the risk of postoperative functional infertility caused by unintentional damage to a complex network of nerves—a preventable complication that is particularly concerning given that testicular cancer primarily affects young males. Nerve-sparing RPLND is an uncommon and complex procedure that surgical trainees may only see a few times during their programs.

In this prospective study, we explored if video learning material combined with human cadaveric training simulation can improve the surgical performance of trainees performing nerve-sparing RPLND. We created a facilitator-led video demonstrating the procedure. After studying paper-based materials on the nerve-sparing RPLND procedure, trainees were tasked with performing one-half of the procedure on human cadavers before and the second-half after watching the video learning material. Their surgical performance was quantitatively assessed. Their surgical procedures were also video-recorded for further qualitative assessment by a blinded expert surgeon. Trainees also qualitatively self-evaluated their own surgical performance.

Significant improvements in performance were seen in the second-half of this procedure, both quantitatively and qualitatively, as evaluated by our expert. The self-assessment score was also significantly improved. These results suggested that the video learning material combined with human cadaveric simulation can improve the surgical performance of trainees and be used for teaching uncommon and complex procedures. It also has the potential to meet the current challenges impacting surgical residency programs today.

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