The combined porcine-avian model: An innovative training tool for paediatric retroperitoneoscopic pyeloplasty

Simulation-based training is increasingly recognised as a cornerstone of modern minimally invasive paediatric surgery, providing a safe environment for deliberate practice despite limited operative exposure. However, training models reproducing the specific ergonomic constraints of paediatric retroperitoneoscopic pyeloplasty remain scarce. Building on our established neonatal avian simulator, we adapted a complementary hybrid model designed to reproduce the anatomical orientation, key procedural steps, and working angles encountered during retroperitoneoscopic dismembered pyeloplasty.

To describe an adapted porcine-avian model for retroperitoneoscopic pyeloplasty and evaluate its face and content validity.

A prospective observational study was conducted during two paediatric minimally invasive surgery (MIS) courses in 2023 and 2024. The model consisted of a chicken crop (a dilated food-storage pouch of the oesophagus) connected to a piglet kidney. The construct was positioned on a support within a tilted pelvitrainer to reproduce the anatomical orientation and operative angles observed during paediatric retroperitoneoscopic pyeloplasty. This setup allowed simulation of dismembered retroperitoneoscopic pyeloplasty using instruments and techniques consistent with clinical practice. The primary outcomes were perceived realism (face validity) and educational value (content validity), assessed using a structured questionnaire based on the Michigan Standard Simulation Experience Scale (MiSSES). Subgroup analyses were performed according to training level and previous pyeloplasty experience.

Twenty-nine participants (20 females, 9 males) were enrolled: 17 (59%) had performed <50 MIS cases, 4 (14%) 50-100 cases, and 8 (28%) >100 cases. Mean perceived realism was 4.4 ± 0.7 overall, for the simulated environment 4.3 ± 0.7, the renal pelvis 4.4 ± 0.6, and the ureter 4.4 ± 0.6. Knowledge improvement was rated 4.7 ± 0.5, confidence performing retroperitoneoscopic pyeloplasty 4.4 ± 0.6, and ability 4.4 ± 0.8. Educational value for retroperitoneoscopic surgery was rated 4.6 ± 0.6, and for suturing 4.8 ± 0.5. Responses were predominantly clustered between scores 4 and 5. Overall satisfaction was 5.0 ± 0.0.

The combined porcine-avian model for retroperitoneoscopic pyeloplasty demonstrated high educational value, strong participant acceptance, and favourable realism ratings. These findings support face and content validity. Further studies using objective performance metrics are required to establish construct and transfer validity.