Reply to Letter to the Editor on “Hypospadias Reconstruction Training: Development of an Ex-Vivo Model and Objective Evaluation of Surgical Skills”

Abstract

Thank you for the opportunity to respond to the comments regarding our article on hypospadias surgery training through a 1-day surgical course. We appreciate the detailed insights provided and would like to address each point raised. • Long-term skill acquisition: We acknowledge that long term, continuous practice is vital for mastering complex motor skills like those involved in surgery. Our study aimed to evaluate immediate skill acquisition following a focused training session. While we believe this initial exploration is important, we recognize the need for further research that examines skill retention and progression over time. Future studies could indeed provide a more comprehensive understanding of how surgical skills develop with ongoing practice and feedback.1,2 • EMG device details: We appreciate the request for additional information regarding the EMG device utilized in our study. We specified the use of the Myo Gesture Control (Thalmic Labs) and provided information about the electrode placement. We understand that further details on device specifications and calibration procedures would enhance reproducibility. We encourage readers to consult the supplementary materials for more in-depth information on the device’s capabilities and setup.3 • Participant posture during measurements: We can confirm that all participants remained seated comfortably throughout the workshop. This consistent posture was maintained during the EMG measurements taken before and after the training to minimize variability in muscle activity readings. We understand the importance of posture in influencing muscle activation and appreciate the suggestion to clarify this aspect. • Future use of EMG: We are enthusiastic about the potential of using EMG to evaluate surgical training more extensively. As this study is the first of its kind in the context of hypospadias training, we view it as a foundational step toward more robust analyses in future research. Our aim is to build upon these initial findings to further explore the relationship between EMG data and surgical skill development. • Anatomical considerations: We are fully aware of the many letters to the editor submitted to several journals by one particular author in an attempt to draw attention and increase references to his own publication. However, we believe that the specific anatomical reports mentioned are outside the primary scope of our study. Our focus was on the efficacy of training methodologies rather than an in-depth exploration of anatomical structures. However, we acknowledge the importance of understanding anatomical differences between species and agree that training in animal models has shown significant benefits in enhancing surgical skills and outcomes.4 We hope our responses clarify the contributions of our study and encourage further exploration in this critical area of training.