Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords: Surgical training, surgical education, surgical model, scrotal surgery, scrotal exploration
Highlight box.
Key findings
• The porcine ex-vivo model for scrotal exploration and orchidopexy successfully develops procedural competency which is sustained short-term.
• The porcine ex-vivo model is positively received by surgical trainees and aids their procedural development as an adjunct to formal theatre training.
What is known and what is new?
• Cadaver and animal models are useful aids to form theatre training in a range of surgical skills and procedures.
• An ex-vivo porcine model for scrotal surgery specifically can successfully train scrotal exploration and orchidopexy in junior surgical trainees.
What is the implication, and what should change now?
• This ex-vivo model holds potential to be implemented into training programs more broadly to train this essential emergency procedure in urology and general surgery.
Introduction
Background
Surgical education is undergoing a paradigm shift toward competency-based and simulation-enhanced models (1). These changes are driven by ethical concerns for patient safety and reduced operative exposure (1). Simulation-based technical skills training provides a safe adjunct to traditional methods by facilitating repetitive, hands-on practice in a low-stakes, non-clinical environment (1,2).
Three-dimensional surgical simulators range from synthetic models to cadaveric specimens and virtual reality experiences (3). Synthetic models vary in their sophistication, yet most cost-effective models lack anatomical detail or provide an unrealistic appreciation of tissues (4-6). While virtual reality simulators offer the advantage of reusability, they routinely lack appropriate haptic feedback which is integral for the development of tissue handling skills and may be difficult to access in rural and regional centres (7). Ex-vivo and cadaver models outperform non-biological simulators in tissue feel and face and content validity (8-11). Cadaveric models are thereby the gold-standard surgical simulation models for open surgery due to their accurate anatomical representation and tissue handling experience (12). While perfused human cadaver models provide optimal anatomical accuracy (13), animal cadaver and ex-vivo models can provide a similar training experience with fewer ethical and logistical constraints (14,15).
Implementation of animal and human cadaver and ex-vivo models in surgical training shows early promising results (2,10,15-20). Cadaver-based education has frequently been reported as the preferred modality to learn operative anatomy and develop procedural confidence (20-24). In an assessment of cadaver-based teaching of a range of basic surgical procedures, improvements in anatomical and procedural knowledge were reported by junior participants and noted by senior surgeons (20). These improvements resulted in a trend to granting participants greater autonomy in the operating theatre after participation in this exercise (20). Improvements in confidence after cadaver and animal model-based education were again demonstrated in a study of over 100 urology trainees at a national emergency urology skills course in the United Kingdom, particularly in critical procedures such as priapism shunts, ureteric reimplantation, and nephrectomy (19). Another study demonstrated sustained confidence at 6 months after training partial or radical nephrectomy, transurethral resection of bladder tumour, transurethral resection of prostate, and ureteroscopy in fresh human cadaver specimens (16).
Cadaver and animal models demonstrate further potential for enhancing technical skills that are transferable to theatre. Structured cadaver-based training in basic surgical or critical care procedures reduces procedure time and facilitates technical improvements, seen through reduced incision sizes, improvements in laparoscopic safety and dexterity, and lower complication rates (25-27). In a randomised-controlled trial of 40 surgical residents training laparoscopic cholecystectomy on porcine models or a virtual reality simulator, the porcine model group demonstrated superior skill transfer to live surgery compared with the virtual reality simulator (28). However, most studies describe participants’ own perceptions of technical improvement rather than objective assessment of skill development. Collectively, the evidence suggests cadaveric models are well-suited for developing transferable technical skills, but high-quality studies objectively measuring performance outcomes are needed.
Cadaver and animal models are particularly useful for training essential emergency procedures which may be underrepresented in formal training (3). Scrotal exploration and orchidopexy is one such procedure that is essential for urological and general surgeons. Exposure to this procedure can be limited given its emergent nature. A low-cost synthetic model for orchiopexy, orchidectomy, and scrotal exploration developed for a military general surgery curriculum has been described (29). However, this model has low anatomical fidelity, does not provide representative haptic feedback, and does not allow start-to-finish, or skin-to-skin, training of this procedure. The national cadaver-based emergency urology course described by Bullock et al. (2020) included scrotal procedures, however these modules were not individually evaluated, and no objective performance metrics were reported (19).
Rationale and knowledge gap
To date, no published studies have systematically validated cadaveric or ex-vivo animal models for scrotal exploration and orchidopexy or objectively assessed their utility in technical skill acquisition. This knowledge, together with a more thorough evaluation of confidence attainment with cadaveric training, is essential to ensure clinical transferability of cadaver models in scrotal surgery.
Objective
In this study, we develop a porcine ex-vivo scrotal model for facilitating skin-to-skin training in scrotal exploration and orchidopexy. Following a half-day training course, we evaluate the efficacy of the porcine model in teaching junior surgical trainees the steps and techniques of scrotal exploration and orchidopexy and assess the success of the model in developing technical competence. We then evaluate whether the porcine model improves trainees’ confidence in performing scrotal exploration and orchiopexy. Finally, we assess the attitudes of surgical trainees to this training method to provide comment on the potential for this model to be implemented as a training tool more broadly. We present this article in accordance with the SQUIRE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-1-890/rc).
Methods
This is a mixed-methods prospective observational study. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Greater Western Human Research Ethics Committee (No. 2025/ETH01319). All participants provided informed consent for participation in this study by signing a paper consent form.
Recruitment
Purposeful recruitment of surgical registrars and senior resident medical officers at our institution was undertaken. Participants were notified of the study via word of mouth and email.
Eligibility criteria
We implemented a purposive sampling methodology over a 2-week period to include participants meeting the following criteria:
❖ Surgical registrars or senior resident medical officers at our institution;
❖ Competent in basic suture technique and knot tying;
❖ Not independent in performing scrotal exploration and orchidopexy.
Specimen acquisition, preparation, and storage
Specimens containing porcine testes, epididymides, spermatic cords, fascial layers, and overlying subcutaneous fat and skin en-bloc were obtained from a local abattoir. Specimens were off-cuts which would otherwise have been disposed of costing AUD$30 per specimen. Additional off-cut skin was obtained from the abattoir to supplement an absent posterior scrotal wall. The off-cut skin was sutured to the anterior wall skin to create a complete scrotum with enclosed structures (Figure 1).
Figure 1.
Ex-vivo porcine model for scrotal exploration and orchidopexy. (A) Porcine specimens containing testes, epididymides, spermatic cords, overlying skin, and connective tissue anteriorly obtained from a local abattoir. (B) A complete scrotal model where a posterior scrotal wall has been created from additional skin sutured to existing anterior skin.
Specimens were stored in a biomaterial-specific refrigerator in our institution in line with local safety protocols. Specimens stored for greater than 24 h were frozen and then defrosted for later use.
Study procedures
Intervention: scrotal exploration and orchidopexy intensive course
A half-day scrotal exploration and orchidopexy training session was conducted at our institution, led by a consultant urologist. The course incorporated a short theoretical review of procedure indications, essential anatomy, procedural steps, and common pitfalls. A practical demonstration on the porcine model was then provided by the consultant urologist (Figure 2). Participants then used the porcine models and basic surgical instruments (needle driver, forceps, scissors) to practice the technique of individual steps of scrotal exploration and orchidopexy. Participants then practiced the steps sequentially on the model to facilitate skin-to-skin training.
Figure 2.
Practical demonstration of the steps of scrotal exploration performed live by a consultant urologist using the porcine model. (A) Incision. (B,C) Dissection. (D) Delivery of testis and inspection. (E,F) Replacement of testis and 3-point orchidopexy. (G) Closure of tunica vaginalis. (H) Closure of dartos and skin.
Assessment: competency in scrotal exploration and orchidopexy
A bespoke structured assessment of competency in scrotal exploration and orchidopexy was developed based on the Objective Structured Assessment of Technical Skill (OSATS) framework (Appendix 1) (30,31). The procedural steps and techniques assessed were informed by described procedural guides and approved by the consultant urologist (32-34). Operative performance of scrotal exploration and orchidopexy was evaluated by a consultant urologist using a structured, procedure-specific assessment checklist. The tool comprises seven key operative steps (patient preparation, midline raphe incision, dissection, testicular examination and detorsion, contralateral exploration, three-point orchidopexy, and closure) each rated on a 3-point scale (0= not performed, 1= performed below standard, 2= performed at standard). This yields a maximum possible score of 14, providing a standardised measure of technical proficiency for comparison across candidates. Adequacy of operative skills was also evaluated by the consultant urologist using a structured assessment checklist. The tool comprises three operative skill competencies (knowledge of procedural steps, instrument choice, and tissue handling) each scored on a 3-point scale (0= below standard, 1= acceptable standard, 2= excellent standard). This yields a maximum possible score of 6 and again provides a standardised measure of proficiency between candidates. Participants were assessed as ‘competent’ if they achieved a score of 14 out of 14 in the operative steps criteria and at least 3 out of 6 (with a score of at least 1 out of 2 in all domains) in the operative skills assessment. The same consultant urologist then re-assessed the participants in both domains 2–8 weeks later.
Assessment: evaluation of the porcine ex-vivo model
An anonymous paper-based assessment of participant attitudes towards the porcine scrotal model was performed immediately after the half-day teaching session. Participant attitudes towards the model were first assessed on a bespoke 11-point survey using a 5-point Likert scale. The survey then concluded with a free-text response inviting written descriptions of feedback regarding the porcine model. Reflexive thematic analysis was performed to analyse free-text feedback regarding the model. Free text responses were transcribed and coded in NVivo 15. Familiarisation, coding, theme development, and theme review were undertaken by two researchers (Z.W., C.S.).
Statistical analysis
GraphPad Prism 10 (RRID: SCR_002798) was used to perform descriptive statistical analysis (median, range, and frequency).
Results
Eight participants were included in this study. Participant demographics are represented in Table 1. The median number of dedicated surgical training years for participants was 2. All participants were competent in basic surgical skills. The majority of participants were pursuing general surgery (n=6), while other participants were pursuing urology (n=1) and vascular surgery (n=1). The median number of scrotal explorations participants had previously participated in was 2. None of the participants were competent as primary operator in scrotal exploration and orchidopexy before undertaking our study.
Table 1. Participant characteristics.
| Participant ID | Years of surgical training | Number of scrotal explorations assisted | Surgical interest (frequency) |
|---|---|---|---|
| 1 | 5 | 5 | General surgery |
| 2 | 1 | 1 | Vascular |
| 3 | 2 | 0 | General surgery |
| 4 | 1 | 2 | Urology |
| 5 | 1 | 1 | General surgery |
| 6 | 2 | 3 | General surgery |
| 7 | 5 | 5 | General surgery |
| 8 | 5 | 6 | General surgery |
| Overall, median [range] | 2 [1-5] | 2.5 [0-6] | Urology (n=1); general surgery (n=6); vascular surgery (n=1) |
Assessments of procedural performance immediately after the educational session and on repeat assessment are reported in Table 2 (Appendix 1). All participants (n=8) achieved competency in performing the appropriate operative steps unprompted at the conclusion of the education session. Similarly by the conclusion of the education session, all participants achieved technical competency in performing these steps to an appropriate standard. All participants (n=7) who presented for repeat assessment at 2 or 8 weeks following the education session demonstrated sustained competency in knowledge of operative steps and technical performance. One participant did not complete repeat assessment due to unavailability.
Table 2. Median participant scores in assessment 1 and assessment 2.
| Assessment criteria | Assessment 1 | Assessment 2 |
|---|---|---|
| Operative steps† | ||
| Preparation (0-2) | 2 [0] | 2 [0] |
| Approach (0-2) | 2 [0] | 2 [0] |
| Dissection (0-2) | 2 [0] | 2 [0] |
| Testis examination (0-2) | 2 [0] | 2 [0] |
| Contralateral exploration (0-2) | 2 [0] | 2 [0] |
| Orchidopexy (0-2) | 2 [0] | 2 [0] |
| Closure (0-2) | 2 [0] | 2 [0] |
| Total (0-14) | 14 [0] | 14 [0] |
| Overall performance‡ | ||
| Knowledge (0-2) | 2 [1] | 2 [0] |
| Instrument Choice (0-2) | 1.5 [1] | 2 [0] |
| Tissue Handling (0-2) | 1.5 [1] | 2 [0] |
| Total (0-6) | 5 [3] | 6 [0] |
| Competency | ||
| Competent | 8 (100%) | 7 (100%) |
| Not competent | 0 (0%) | 0 (0%) |
Data are presented as median [range] or frequency (percentage). †, 0= not performed, 1= performed below standard, 2= performed at standard; ‡, 0= below standard, 1= acceptable standard, 2= excellent standard.
Participant attitudes towards the animal model as an adjunct to procedural training are reported in Table 3 (Appendix 2). All participants ‘agreed’ or ‘strongly agreed’ the porcine model improved their 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. The median overall satisfaction score with the porcine model as an adjunct to training scrotal exploration and orchidopexy was 5 out of 5 Likert points (range =1). The median score provided to our model for improving procedural confidence and personal perception of technical skill was 5 out of 5 Likert points (range =1).
Table 3. Survey results of participant attitudes towards the porcine ex-vivo model of scrotal exploration measured on a 5-point Likert scale.
| Statement regarding use of the animal cadaver model | Score (5 Likert points), median [range] |
|---|---|
| Improved knowledge of procedural steps | 5 [1] |
| Improved knowledge of complications and management strategies | 4 [1] |
| Improved appreciation of anatomy | 5 [1] |
| Improved understanding of tissue handling techniques | 5 [1] |
| Improved understanding of appropriate surgical tools | 5 [1] |
| Facilitated practice of individual procedural steps | 5 [1] |
| Facilitated practice of consecutive steps (skin-to-skin) | 5 [1] |
| Improved confidence | 5 [1] |
| Improved technical skill | 5 [1] |
| Satisfaction score | 5 [1] |
Thematic analysis of participant attitudes towards the porcine model for scrotal exploration and orchidopexy is reported in Table 4. The model was positively received. Consistent positive aspects of the model included the anatomical accuracy of the model which facilitated understanding of tissue layers. The non-clinical cadaver-based approach was also positively received as participants were able to practice procedural techniques without concern for patient harm or other time-based stressors. The anatomical accuracy and wet-specimen nature of the model combined with the non-clinical environment allowed participants to explore new approaches to tissue dissection. Drawbacks of the model included the lack of perfusion or use of diathermy to respond to bleeding and the large size of the model which reduced realism in simulating human scrotal surgery.
Table 4. Thematic analysis of participant attitudes towards the porcine model of scrotal exploration and orchidopexy.
| Theme | Description | Representative quotes |
|---|---|---|
| Anatomical appreciation | Participants indicated the model was helpful to appreciate anatomical landmarks relevant to the procedure | “The model was helpful to appreciate layers” |
| Technical skill development | Participants indicated the model was helpful in developing their surgical approach and technical performance of dissection | “The model was helpful to appreciate how to…approach dissection” |
| Surgical realism | Participants indicated drawbacks of the model which limited surgical realism including the larger size of the model and the absence of perfusion | “The size was the least realistic part of the model”; “Drawback of the model was the differing anatomical size to human scrotum including paediatric patients”; “Size was a hindrance”; “Unable to appreciate impact of bleeding” |
| Non-clinical training environment | Participants indicated the non-clinical training environment enhanced focus and allowed more bold exploration of surgical techniques given absence of concern for patient harm | “Tutorial environment was a very effective teaching environment as there was no pressure from pager/on call phone/other pressing commitments”; “Great way to practice without concern for causing patient harm or consequence of technical mistakes”; “Allowed opportunity to experiment with different approaches to the procedure without consequence of mistakes” |
| Overall impression | Overall, the model was positively received | “Great basic tool”; “Great model” |
Discussion
Key findings
We present a novel ex-vivo porcine scrotal model for training scrotal exploration and orchidopexy. We demonstrate the success of the model in facilitating skin-to-skin performance of this procedure and in upskilling trainees to a level of sustained procedural competence on immediate and delayed assessment. Competence in our study represented an assessment by a consultant urologist of the trainee demonstrating appropriate knowledge and technical skill to complete the procedure. We also demonstrate improved trainee procedural confidence and overall satisfaction with the ex-vivo porcine scrotal model as a training modality for scrotal exploration and orchidopexy.
While the porcine model is overall successful in facilitating training in scrotal exploration and orchidopexy, the model has a few limitations. Firstly, the large size of the model may impact the translation of procedural competency to patients. However, the anatomical accuracy in this larger-sized model also enhanced appreciation of anatomy, particularly tissue layers, which added to the training experience. Similarly, the use of a non-perfused ex-vivo model limited surgical realism due to the absence of bleeding and requirement for diathermy.
The benefits of the porcine scrotal model demonstrated in our study are broad. For surgical trainees, the model provides structured, realistic training in an emergent, time-critical procedure. The model provides opportunities to make errors without consequence, reducing trainee hesitancy. For surgical educators, the study offers validated evidence to inform curriculum design and resource allocation. It is expected that the model would shorten the scrotal exploration and orchidopexy learning curve, reducing the supervision required for trainees performing this procedure.
The porcine scrotal model endears potential for scalability of our approach to a broader surgical audience. Tactile feedback provided by porcine cadaveric tissue provides greater fidelity, surpassing other simulation options in early training. Similarly, the low cost and relative availability of scrotal off-cuts provide potential for this model to formally complement traditional urological training. Exploration of this avenue for future urological training may then be extended to include a broader range of urological procedures (11).
Comparison with similar research
Our study addresses a critical gap in the surgical education literature by using a robust methodology to evaluate a porcine scrotal model for training in scrotal exploration and orchidopexy. Studies of cadaver models in scrotal surgery use low-quality or anatomically inaccurate models (29), or evaluate scrotal procedures as part of broader cadaveric training curriculum without specific scrotal cadaver model assessment (19). No published studies have objectively evaluated technical skill attainment and retention in scrotal surgery using animal models. This knowledge, together with a more thorough evaluation of confidence attainment and retention, is essential to determine the transferability of skills attained from the porcine models to the clinical setting. By incorporating an objective assessment tool validated by local urologists, this study provides robust evidence on procedural competency attainment and retention. In our study, procedural ‘competency’ was awarded if participants demonstrated a minimum standard in recall of procedural steps and quality of performance of these steps. This assessment of competency was robust in that it followed the validated OSATS framework (Appendix 1) (30,31). This approach directly addresses the methodological limitations of prior studies that relied primarily on subjective participant ratings of skill attainment and rarely evaluated skill retention. The parallel evaluation of participants’ confidence and attitudes towards the cadaver model provides a comprehensive perspective on both the education potential of the model and the transferability of attained skills to the clinical setting.
Strengths and limitations
This study has a few limitations. Firstly, there is variation in the time interval between the first and second competency assessments. Most participants repeated their assessment at 8 weeks, however two participants required earlier assessment due to unavailability and one participant did not complete the second competency assessment due to unavailability. While all participants retained technical competency on reassessment of performance of scrotal exploration and orchidopexy on the porcine ex-vivo model, the relatively short follow-up period limits understanding of longer-term skill retention. Time frames for short and long-term retention of knowledge or technical skill are not consistently reported in the literature and as such our study aimed to conduct follow-up assessment at a time frame deemed reasonable by the study investigators (8 weeks) and when both assessors and participants were available. Frequent rotation of participants to new training sites and external commitments of study investigators limited longer-term competency assessment in this study. This could be explored in future studies of this animal model. Secondly, a single consultant assessed participants in attainment and retention of procedural competency. A single, unblinded assessor introduced potential for bias in the assessment of participants in our study. While the single assessor in our study did reduce accuracy and validity, the single assessor was appropriate in the pilot context of our study. Importantly, the assessor was kept consistent between initial and repeat assessments which allowed for a valuable comparison of results at two time periods. To strengthen this methodology if performed on a larger scale, inter-user variability could be assessed by introducing multiple assessors, and intra-user variability could be assessed by filming participants and requiring assessors to score the same performance multiple times. Thirdly, given our study piloted the ex-vivo porcine model, we did not include a control group, such as a synthetic model, in our study. The absence of a control group limits effectiveness of our conclusions as it does not provide a head-to-head trial of the porcine model compared with other models of teaching. However, the study successfully assesses participant attitudes towards the novel porcine ex-vivo model of scrotal exploration and orchidopexy and demonstrates attainment and retention of operative competency using this approach. Following this pilot study of the porcine ex-vivo model, future studies could perform a head-to-head comparison of varying educational techniques in this procedure. Finally, qualitative analysis was limited to short paragraph free-text feedback provided by participants. However, given the breadth of literature available on surgical models, this short feedback still facilitated meaningful analysis of emerging themes which could then be compared with themes identified in the literature.
Conclusions
Overall, this study demonstrates the success of a novel porcine scrotal model in facilitating skin-to-skin training in scrotal exploration and orchidopexy for junior surgeons in regional Australia. This study demonstrates the timely acquisition of procedural competency and confidence and the retention of procedural competency after training on the porcine model. The overall satisfaction with the porcine model and cost-effectiveness of this training modality provides promise for the scalability of the model and development of similar models for training in other urological procedures.
Supplementary
The article’s supplementary files as
Acknowledgments
We acknowledge the support of Wagga Wagga Base Hospital staff in providing facilities to conduct this study.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Greater Western Human Research Ethics Committee (No. 2025/ETH01319). All participants provided informed consent for participation in this study by signing a paper consent form.
Footnotes
Reporting Checklist: The authors have completed the SQUIRE reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-1-890/rc
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2025-1-890/coif). The authors have no conflicts of interest to declare.
Data Sharing Statement
Available at https://tau.amegroups.com/article/view/10.21037/tau-2025-1-890/dss
References
- 1.Akhtar KS, Chen A, Standfield NJ, et al. The role of simulation in developing surgical skills. Curr Rev Musculoskelet Med 2014;7:155-60. 10.1007/s12178-014-9209-z [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Young M, Kailavasan M, Taylor J, et al. The Success and Evolution of a Urological "Boot Camp" for Newly Appointed UK Urology Registrars: Incorporating Simulation, Nontechnical Skills and Assessment. J Surg Educ 2019;76:1425-32. 10.1016/j.jsurg.2019.04.005 [DOI] [PubMed] [Google Scholar]
- 3.Davidson EL, Penniston KL, Farhat WA. Advancements in surgical education: exploring animal and simulation models in fetal and neonatal surgery training. Front Pediatr 2024;12:1402596. 10.3389/fped.2024.1402596 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Smail Y, Codjia F, Attal JP, et al. Perceptions of the use of a 3D-printed manufactured educational simulator for incisions and sutures. BMC Med Educ 2025;25:1177. 10.1186/s12909-025-07779-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Balaji A, Makam R, Balaji A, et al. Realising ideal home practice models for surgical skill development. J Surg Res (Houst) 2025;8:437-41. [Google Scholar]
- 6.Salib J, Salib M, Phillips M. Low-Cost Simulation Kits for Surgical Training in Resource-Limited Settings: A Student-Led Model. Cureus 2025;17:e95940. 10.7759/cureus.95940 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Shahrezaei A, Sohani M, Taherkhani S, et al. The impact of surgical simulation and training technologies on general surgery education. BMC Med Educ 2024;24:1297. 10.1186/s12909-024-06299-w [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Al-Jabir A, Aydin A, Al-Jabir H, et al. Current status of wet lab and cadaveric simulation in urological training: A systematic review. Can Urol Assoc J 2020;14:E594-600. 10.5489/cuaj.6520 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Sharma M, Horgan A. Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training. World J Surg 2012;36:1732-7. 10.1007/s00268-012-1564-6 [DOI] [PubMed] [Google Scholar]
- 10.Strohmaier WL, Giese A. Porcine urinary tract as a training model for ureteroscopy. Urol Int 2001;66:30-2. 10.1159/000056559 [DOI] [PubMed] [Google Scholar]
- 11.Rashid P, Gianduzzo TR. Urology technical and non-technical skills development: the emerging role of simulation. BJU Int 2016;117 Suppl 4:9-16. 10.1111/bju.13259 [DOI] [PubMed] [Google Scholar]
- 12.Badash I, Burtt K, Solorzano CA, et al. Innovations in surgery simulation: a review of past, current and future techniques. Ann Transl Med 2016;4:453. 10.21037/atm.2016.12.24 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Katz R, Hoznek A, Antiphon P, et al. Cadaveric versus porcine models in urological laparoscopic training. Urol Int 2003;71:310-5. 10.1159/000072684 [DOI] [PubMed] [Google Scholar]
- 14.Varner C, Dixon L, Simons MC. The Past, Present, and Future: A Discussion of Cadaver Use in Medical and Veterinary Education. Front Vet Sci 2021;8:720740. 10.3389/fvets.2021.720740 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Stefanidis D, Yonce TC, Green JM, et al. Cadavers versus pigs: which are better for procedural training of surgery residents outside the OR? Surgery 2013;154:34-7. 10.1016/j.surg.2013.05.001 [DOI] [PubMed] [Google Scholar]
- 16.McClelland D, O'Connor LP, Barnard J, et al. The utilization of perfused cadaver simulation in urologic training: a pilot study. BMC Urol 2021;21:134. 10.1186/s12894-021-00895-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Laird A, Stewart GD, Hou S, et al. A novel bovine model for training urological surgeons in laparoscopic radical nephrectomy. J Endourol 2011;25:1377-83. 10.1089/end.2011.0060 [DOI] [PubMed] [Google Scholar]
- 18.Fujikawa T, Homma H, Ishii Y, et al. Training in trauma surgical techniques using cryopreserved porcine organs. Acute Med Surg 2024;11:e70018. 10.1002/ams2.70018 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Bullock N, Ellul T, Biers S, et al. Establishing a national high fidelity cadaveric emergency urology simulation course to increase trainee preparedness for independent on-call practice: a prospective observational study. BMC Med Educ 2020;20:349. 10.1186/s12909-020-02268-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Lewis CE, Peacock WJ, Tillou A, et al. A novel cadaver-based educational program in general surgery training. J Surg Educ 2012;69:693-8. 10.1016/j.jsurg.2012.06.013 [DOI] [PubMed] [Google Scholar]
- 21.Kim SC, Fisher JG, Delman KA, et al. Cadaver-Based Simulation Increases Resident Confidence, Initial Exposure to Fundamental Techniques, and May Augment Operative Autonomy. J Surg Educ 2016;73:e33-41. 10.1016/j.jsurg.2016.06.014 [DOI] [PubMed] [Google Scholar]
- 22.Sheckter CC, Kane JT, Minneti M, et al. Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. J Surg Educ 2013;70:466-74. 10.1016/j.jsurg.2013.02.008 [DOI] [PubMed] [Google Scholar]
- 23.Robinson WP, Doucet DR, Simons JP, et al. An intensive vascular surgical skills and simulation course for vascular trainees improves procedural knowledge and self-rated procedural competence. J Vasc Surg 2017;65:907-915.e3. 10.1016/j.jvs.2016.12.065 [DOI] [PubMed] [Google Scholar]
- 24.Jansen S, Cowie M, Linehan J, et al. Fresh frozen cadaver workshops for advanced vascular surgical training. ANZ J Surg 2014;84:877-80. 10.1111/ans.12361 [DOI] [PubMed] [Google Scholar]
- 25.Martin M, Vashisht B, Frezza E, et al. Competency-based instruction in critical invasive skills improves both resident performance and patient safety. Surgery 1998;124:313-7. [PubMed] [Google Scholar]
- 26.Wong K, Stewart F. Competency-based training of basic trainees using human cadavers. ANZ J Surg 2004;74:639-42. 10.1111/j.1445-1433.2004.03110.x [DOI] [PubMed] [Google Scholar]
- 27.Sharma M, Macafee D, Horgan AF. Basic laparoscopic skills training using fresh frozen cadaver: a randomized controlled trial. Am J Surg 2013;206:23-31. 10.1016/j.amjsurg.2012.10.037 [DOI] [PubMed] [Google Scholar]
- 28.Van Bruwaene S, Schijven MP, Napolitano D, et al. Porcine cadaver organ or virtual-reality simulation training for laparoscopic cholecystectomy: a randomized, controlled trial. J Surg Educ 2015;72:483-90. 10.1016/j.jsurg.2014.11.015 [DOI] [PubMed] [Google Scholar]
- 29.Hafer AS, Sweeney WB, Battista AL, et al. Development and Implementation of Urologic Care Army/Air Force/Navy Provider Education, a Urologic Emergency Simulation Curriculum. Mil Med 2023;188:817-23. 10.1093/milmed/usac003 [DOI] [PubMed] [Google Scholar]
- 30.Martin JA, Regehr G, Reznick R, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84:273-8. 10.1046/j.1365-2168.1997.02502.x [DOI] [PubMed] [Google Scholar]
- 31.Niitsu H, Hirabayashi N, Yoshimitsu M, et al. Using the Objective Structured Assessment of Technical Skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today 2013;43:271-5. 10.1007/s00595-012-0313-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Clement KD, Light A, Asif A, et al. A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion: the Finding consensus for orchIdopeXy In Torsion (FIX-IT) study. BJU Int 2022;130:662-70. 10.1111/bju.15818 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Davis R, Oundoh L, Axt J. Orchidopexy and orchiectomy for testicular torsion. Open Manual of Surgery in Resource-Limited Settings. Availale online: https://www.vumc.org/global-surgical-atlas/sites/default/files/public_files/PDF/Orchiectomy%20and%20Orchipexy%20for%20Testicular%20Torsion.pdf
- 34.Please H, Savopoulos V, Biyani CS. Essential skills of scrotal examination: a step-by-step technique. Trend Urol Mens Heal 2022;13:9-13. [Google Scholar]