A Low-Cost Model for Technical Instruction of Transperineal Ultrasound-Guided Prostate Biopsy (TPPB)
Jonathan T. Xu, MD, Caroline Ricard, MD, Deanna Plewa, DO, Nicholas Jonas, MD, William Faust, MD.
Lahey Clinic, Burlington, MA, USA.
BACKGROUND: Transperineal Prostate Biopsy (TPPB) is gaining widespread interest for prostate cancer diagnosis, in part due to its lower rates of infection compared to its transrectal counterpart. Few models exist to assist trainees with acquiring the skills needed for TPPB, and those that do are costly. We have constructed a low-cost, easily replicable TPPB model. Herein we describe the model and assess trainees' experience with respect to model realism and effectiveness.
METHODS: We created a low-cost TPPB model using store-bought supplies. A concentration of 0.28% psyllium and 15% gelatin mixture in water was placed in a prostate mold to create a 3-D prostate. Beets were used to represent hyperechoic target "lesions" within the prostate. The perineal soft tissue was simulated using 3.7% psyllium and 15% gelatin mixture in water via a plastic container. A wooden dowel was inserted to create a simulated rectum, and the prostate was suspended in anatomic position in relation to the rectum as the solution cured. Trainees were asked to perform TPPB using the low-cost TPPB model with expert demonstration and supervision. Participant satisfaction was assessed pre and post simulation exercise.
RESULTS: Total cost per individual prostate model was approximately $11.90. 15 trainees ranging from MS3 to PGY5 participated in the TPPB simulation. 93% of participants "agreed" or "strongly agreed" that the model was effective for technical instruction; 80% of participants "strongly agreed" that the model was superior to verbal or pictorial methods for understanding TPPB. Lastly, 93% of participants "agreed" or "strongly agreed" on model verisimilitude to in situ TPPB.
CONCLUSIONS: We describe an inexpensive and reproducible TPPB model. This was found to be an effective and realistic kinesthetic learning tool for trainees based on feedback from our initial simulation. We will continue to improve upon model fidelity; future studies will aim to assess our model's effects on trainee performance and confidence in performing TPPB in situ. 
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