WOFAPS 2025 8th World Congress of Pediatric Surgery

Yosra Ben Ahmed ¹, Mariem Marzouki ¹, Imen kalfat ¹, Rami Boulma ², Intissar Chibani ¹, Faouzi Nouira ¹, Said Jlidi ¹

¹ Children Hospital Bechir Hamza, Pediatric surgery department B. Tunis, Tunisia
² Faculty of Medecine of Tunis. Tunisia

Lich-Gregoir uretero-vesical reimplantation is not widespread in pediatric surgery and little known by young learners, even though it constitutes the technique of choice for laparoscopic ureteral reimplantation. This study aimed to evaluate the effectiveness of a low-fidelity simulation model for extra-vesical laparoscopic ureteral reimplantation using the Lich-Gregoir technique.

Methods This was a cross-sectional study carried out among residents in pediatric and urological surgery who already had laparoscopic experience of at least three surgeries as first aid. Two simulation sessions with two-hour training on the laparotrainer were organized. A timed final evaluation and a satisfaction test were carried out.

Results We included 15 residents (14 paediatric surgery and one urology). All our participants had already participated in at least ten interventions as an operating aid. Thirteen patients had already performed a laparoscopic procedure as operators.

After two hours of training, 13 participants were able to successfully complete the procedure, the average duration was 67.3 minutes (55 to 90 minutes). Posture, equipment holding and respect for triangulation were judged satisfactory to very good for 13 residents. The section of the muscularis lasted on average 14 minutes with seven perforations of the mucosa. The most difficult stage, for all of them, was achieving the stitches with an average of 33 minutes (30 and 45 minutes). This step was judged fair to insufficient for ten of the participants.

The model was considered realistic by 12 residents. More than two thirds of participants found that the representation of the bladder, detrusor and ureters was sufficiently realistic, but needed improvement. Thirteen participants suggested improving in the detrusor texture to be more elastic and closer to reality.

Conclusion Our simulation model was easy to make, economical and made of simple materials, simulating bladder anatomy. It allowed learners to practice dissection, muscle sectioning and tying, thus meet many of their learning objectives in pediatric urological laparoscopy.