Retropubic trocar modified with a load cell to verify contact with pubic bone.

Area of Science:

• Urology
• Surgical Simulation
• Medical Device Innovation

Background:

• Midurethral sling surgery carries risks of vital injuries due to the blind nature of trocar passage.
• Monitoring trocar-bone contact is crucial but challenging for teaching surgeons.
• A novel retropubic trocar equipped with a load cell was developed to detect bone contact during surgery.

Purpose of the Study:

• To evaluate the biofidelity and test-retest reliability of a modified retropubic trocar on a 3D surgical simulator.
• To assess the trocar's ability to differentiate between on-bone and off-bone movements.
• To determine the potential of this device in enhancing surgical training and patient safety.

Main Methods:

• The modified trocar was tested on a 3D midurethral sling surgery simulator using expert and novice surgeons.
• Surgeons performed retropubic trocar passage on a physical pelvic floor model.
• Performance metrics including force variables were analyzed and compared between experts and novices, and between cadaveric and model testing.

Main Results:

• The modified trocar demonstrated adequate biofidelity, with similar force readings between cadaveric and model testing (P = .62).
• High test-retest reliability was observed, with similar force variables across repeated trials (P = .30).
• Expert surgeons showed significantly different force application patterns compared to novices, indicating the simulator's ability to discern skill levels.

Conclusions:

• The modified trocar exhibits high test-retest reliability and adequate biofidelity for surgical simulation.
• This innovative device can assist novice surgeons in maintaining correct trocar placement during midurethral sling procedures.
• The trocar has potential applications in both surgical simulation and the operating room to enhance surgical safety and monitoring.