Development and Validation of a 3D Laparoscopic Retropertioneal Dissection Model

INTRODUCTION: Simulation-based training allows learners to develop and refine skills prior to performing them live. Competency in advanced laparoscopic techniques are milestone requirements for fellows in minimally invasive gynecologic surgery (MIGS). While studies show that low-fidelity simulations can improve traditional retroperitoneal dissection learning, existing models have not been designed to address other advanced skills such as ureterolysis or endometriosis excision. This highlights the need for realistic simulation of these advanced techniques to fill learning gaps for trainees across all gynecologic surgical fellowships. OBJECTIVE: This study aimed to describe the development a low-fidelity laparoscopic 3D retroperitoneal dissection model and to evaluate its validity as an educational surgical simulation tool. METHODS: A 3D-printed model of the peritoneum and retroperitoneal structures was developed, incorporating key anatomical elements such as the vasculature (hypogastric artery, uterine artery, and medial umbilical ligament), ureter, and peritoneum, made from a rubber-silicone compound. The model was mounted within a plastic bowl to replicate the female bony pelvis. This pilot validation study included a total of 13 gynecologic surgeons (6 subspecialty attending gynecologic surgeons and 7 gynecologic surgery fellows). After completing a presimulation survey and viewing an instructional video, participants performed simulation tasks using a laparoscopic box trainer, including endometriosis excision, retroperitoneal dissection, and ureterolysis. Finally, participants completed a post-simulation survey to assess the model’s realism and utility as an educational tool. Survey responses were then deidentified for analysis. RESULTS: A total of 13 participants completed the required surveys and simulation exercises for inclusion in the final analysis. All participants “strongly agreed” that retroperitoneal dissection and ureterolysis are important skills to learn during training. Most participants (76%) rated other currently available simulations inadequate in providing sufficient learning for mastery of laparoscopic endometriosis excision, retroperitoneal dissection, and ureterolysis. Study participants provided a median rating of 5 (scale: 1–Poor; 5–Excellent) for overall experience with this novel laparoscopic simulation exercise, and 69% agreed that the simulation resembled live surgery. A majority (92%) of participants felt that the model provided realistic simulation of laparoscopic endometriosis excision; 84% agreed that the model is a realistic simulation of retroperitoneal dissection; and 69% found it realistic for ureterolysis. All participants agreed that the model accurately represented anatomic relationships of retroperitoneal structures and spaces. All participants agreed that the model is useful for learning and teaching laparoscopic retroperitoneal dissection. Most participants (92%) believed the model is useful for teaching both laparoscopic ureterolysis and excision of endometriosis. Regarding assessment of trainee ability, 84% of study participants agreed that the model is useful in assessing trainee skill prior to live performance. CONCLUSIONS: This study highlights the importance of advanced laparoscopic skills education and identifies a gap in existing simulation resources. Study participants rated this novel model highly for its realism in simulating laparoscopic ureterolysis and endometriosis excision. Moreover, this model received unanimous agreement among both fellow and attending surgeons as an effective tool for teaching complex laparoscopic skills, such as retroperitoneal dissection (Figure 1).