(Poster 34) Validation of a Boari Flap Teaching Simulation Using a Porcine Model

Objectives: Ureteral reimplantation with Boari flap creation is not commonly observed or practiced by trainees in OB/GYN and urology. An existing model for a teaching simulation of Boari flap creation has not yet been described in the literature. The objective of this study was to both develop and validate a novel, high-fidelity simulation designed for practicing Boari flap creation with ureteral reimplantation.

Methods: A high-fidelity model was created using a porcine bladder to simulate Boari flap creation in the setting of an open abdominal ureteral reimplantation. Trainees at a single academic teaching hospital viewed a video previously published by the authors demonstrating the simulation before performing the tasks. Face validity of the model was assessed based on answers to questionnaires administered prior to and after completing the simulation. Level of trainee understanding and knowledge of the procedure before and after completing the simulation was also assessed.

Results: Eighteen trainees, including 17 urogynecology fellows and 1 OB/GYN resident, completed the simulation and written questionnaires. The median age of participants was 32 years and 89% were right-handed. Fourteen participants identified as female and 4 participants identified as male. The majority (61%) of participants had never seen a ureteral reimplant procedure. Five (28%) had seen 1-2, and 2 (11%) had seen 3-5 ureteral reimplant procedures, respectively, in their careers. None of the participants had ever performed a ureteral reimplant or Boari flap. 13/18 (72%) of participants “agreed” or “strongly agreed” that the porcine model reasonably approximated the look and feel of a human bladder in open surgery. When answering the question “The training model appears useful for teaching and learning the procedure,” 100% of participants “agreed” or “strongly agreed”. Additionally, 10/18 (56%) and 8/18 (44%) “agreed” or “strongly agreed” that they felt confident in describing the steps of the Boari flap procedure after completing the simulation. All participants “agreed” or “strongly agreed” that they felt confident in performing the procedure after the simulation.

Conclusions: OB/GYN and urology trainees have minimal exposure to ureteral reimplant techniques specifically involving Boari flap creation. This simulation is a realistic model of Boari flap creation that trainees can utilize to practice this procedure.