Source of Funding: none MP22-07 LAPAROSCOPIC IVC INJURY MANAGEMENT TRAINING e PREDICTING TECHNICAL & NON-TECHNICAL SKILLS Jason Lee*, Udi Blankstein, Richard Hoang, Michael Ordon, Kenneth Pace, Toronto, Canada INTRODUCTION AND OBJECTIVES: Major vascular injuries during laparoscopic surgery, though rare, can lead to significant patient morbidity. Simulation-based team training (SBTT) provides an oppor- tunity to experience such rare OR crisis scenarios in a safe environ- ment, working on both technical & non-technical skills. We developed a unique SBTT laparoscopic IVC injury scenario and conducted an observational study to determine predictors of surgeon performance. METHODS: Urology residents from our institution were recruited to participate in a SBTT laparoscopic nephrectomy exercise (trainees were unaware of complications). Residents completed both a demographic & multidimensional personality questionnaire (BFI) and were instructed to play the role of staff urologist. Study confederates included an anesthesiologist, surgical assistant, and scrub nurse. A vasovagal response to pneumoperitoneum and an IVC injury event were scripted into the scenario. Resident performance in managing these events was video-recorded. All scenarios ended with either successful repair of the IVC injury, decision to convert to open repair, or max blood loss (2.5L). Technical and non-technical (NOTSS) skills were assessed by expert laparoscopic surgeons using validated tools. The Chi-square, Mann-Whitney U, ANOVA, and Pearson and Spearman correlations were utilized as indicated for statistical analysis. RESULTS: Fifteen urology residents participated (10 Jr & 5 Sr residents). Mean EBL was 1.98L and 5 residents were unable to complete the exercise safely. Sr residents had more laparoscopic ne- phrectomy experience (p<0.01) but were similar to Jr residents in prior SBTT experience and on baseline BFI personality scores. Sr residents outperformed Jrs on both technical (15.1 vs 9.9, p<0.01) and NOTSS performance (13.8 vs 10.1, p¼0.03). Technical score correlated with NOTSS score (p<0.01) and pass/fail rating correlated with technical performance (p<0.01), NOTSS score (p¼0.02), and EBL (p<0.01). Only the conscientiousness dimension of the BFI correlated with tech- nical score (p¼0.03) and pass/fail rating (p¼0.04). Of the 4 NOTSS domains assessed, level of training correlated with situation awareness, decision making, and leadership scores but not with communication scores (p¼0.09). CONCLUSIONS: Resident level of training and laparoscopic experience correlated with technical and non-technical performance during a simulated laparoscopic IVC injury scenario. Conscientiousness may correlate with resident technical performance. Level of training alone does not seem to predict communication & teamwork skills. Source of Funding: none MP22-08 INTRAOPERATIVE MRI-GUIDED NAVIGATION OF THE PELVIC FLOOR DURING CLASSIC BLADDER EXSTROPHY AND CLOACAL EXSTROPHY CLOSURE - CUTTING EDGE TECHNOLOGY FOR SURGICAL SKILL EDUCATION Heather Di Carlo*, Baltimore, MD; Eric Massanyi, Akron, OH; Bhavik Shah, Tampa, FL; Aylin Tekes, John Gearhart, Baltimore, MD INTRODUCTION AND OBJECTIVES: Radical dissection of the urogenital fibers and the thickened smooth and striated muscle fibers connecting the posterior urethra and bladder plate to the diastatic pubic rami is crucial for adequate placement of the posterior vesicourethral unit deep within the pelvis during classic bladder exstrophy (CBE) and cloacal exstrophy (CE) closure, as well as ensuring successful out- comes. Intraoperative magnetic resonance imaging (MRI) guided nav- igation of the pelvic floor offers a novel technique for identification of the urogenital diaphragm fibers and the thickened muscular attachments between the posterior urethra, bladder plate and pubic rami during CBE and CE closure, allowing precise surgical skill education in this crucial step of reconstructive surgery. METHODS: Institutional review board and Food and Drug Administration approval was obtained for use of Brainlabâ (Munich, Germany) intraoperative MRI-guided navigation of the pelvic floor anatomy during closure of CBE and CE at the authors’ institution. Pre- operative pelvic MRI was obtained one day prior to CBE or CE closure in patients necessitating pelvic osteotomies. Intraoperative registration was performed after pre-operative planning with a pediatric radiologist utilizing five anatomic landmarks immediately prior to initiation of sur- gery. Accuracy of identification of pelvic anatomy was assessed by three pediatric urologic surgeons and one pediatric radiologist. RESULTS: Eighteen patients with CBE and two patients with CE closed at the authors’ institution have successfully utilized Brainlabâ technology to navigate and guide the dissection of the pelvic floor intraoperatively. All patients had 100% accuracy in correlation of gross anatomic landmarks with MRI identified landmarks intra- operatively, and all have had successful closure of CBE or CE without any complication. CONCLUSIONS: Brainlabâ intraoperative MRI-guided pelvic floor navigation and dissection is an effective way to accurately identify pelvic anatomy during CBE and CE closure. This technology offers a unique opportunity for surgical skill education in this complex recon- structive operation. Future assessment of real-time changes in pelvic floor anatomy comparing pre-closure to post-closure MRI will allow quantification of pelvic floor anatomy in CBE and CE patients and may allow for intra-institutional telementoring in this most important first step of exstrophy reconstruction. Source of Funding: none MP22-09 DEVELOPMENT AND VALIDATION OF AN INTEGRATED SKILLS CURRICULUM WITHIN URETEROSCOPYe A RANDOMISED CONTROLLED TRIAL Oliver Brunckhorst*, Shahab Shahid, Abdullatif Aydin, London, United Kingdom; Craig McIlhenny, Larbet, United Kingdom; Shahid Khan, Redhill, United Kingdom; Syed Raza, Buffalo, NY; Arun Sahai, James Brewin, Fernando Bello, Roger Kneebone, Muhammad Khan, Prokar Dasgupta, Kamran Ahmed, London, United Kingdom INTRODUCTION AND OBJECTIVES: Within ureteroscopy various training modalities have been developed, however for best e244 THE JOURNAL OF UROLOGY â Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015