A porcine ex-vivo model to train scrotal exploration in a regional Australian centre: a pilot study

Animal models provide useful adjuncts to technical skills training in surgery. Animal models are particularly useful for training basic emergency procedures, such as scrotal exploration and orchidopexy, where trainee exposure is limited. There is a scarcity of studies validating animal models for scrotal exploration and orchidopexy. Urology and general surgical trainees thereby have limited access to training opportunities in this procedure. In response to this gap in surgical education, we developed a porcine ex-vivo scrotal model for skin-to-skin teaching of scrotal exploration and orchidopexy. We sought to pilot this model and to determine whether the model improved trainees' competency in performing scrotal exploration and orchidopexy.

We conducted a mixed-methods prospective observational study. A scrotal surgery model was developed using porcine scrotal specimens. Eight junior surgical registrars or senior resident medical officers at Wagga Wagga Base Hospital participated in a half-day education session on scrotal exploration and orchidopexy led by a consultant urologist. Participants practiced procedural steps on the porcine model while receiving technical instruction from a urologist. At the conclusion of the session, participants' performances of scrotal exploration and orchidopexy on the porcine model were assessed for procedural competency using a bespoke assessment tool based on the Objective Structured Assessment of Technical Skill (OSATS) for Surgical Residents template. Repeat assessment was performed at 2-8 weeks. Participant attitudes towards the porcine scrotal model as a surgical training tool were assessed in a bespoke 5-point Likert scale survey and free-text response. Descriptive statistics and reflexive thematic analysis of free-text responses were performed.

All participants (n=8) achieved procedural competency (by performing all operative steps unprompted and with appropriate technique and skill) using the porcine model. At reassessment 2-8 weeks later, competency was retained by every participant. All participants reported the porcine model improved knowledge of anatomy, procedural steps, appropriate surgical tools, tissue handling techniques, strategies to address procedural difficulties, and personal perception of knowledge and technical skill in performing scrotal exploration and orchidopexy. Satisfaction with the model as a teaching aid was high, with all respondents' 5-point Likert scale animal model survey feedback reporting they were 'satisfied' or 'very satisfied' with the model. Limitations included the absence of bleeding, and size discrepancy between the model and human tissue.

This study demonstrates the success of a novel porcine ex-vivo model in facilitating teaching of scrotal exploration and orchidopexy for junior surgeons in regional Australia. This pilot study demonstrates acquisition and retention of competency with a porcine model which may facilitate broader education in this emergency procedure to urology and general surgical trainees.