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Romantini F, Biferi D, Maselli G, Narcisi F, Ranieri M, Topazio L. The role of irrigation fluid in transurethral resection of the prostate outcomes and surgeon performance. Arch Ital Urol Androl 2023; 95:11868. [PMID: 38193228 DOI: 10.4081/aiua.2023.11868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) is the gold-standard for the treatment of benign prostate enlargement (BPE) associated with lower urinary tract symptoms (LUTS), after failure of conservative therapy. At present, only resection-rate (grams of prostate resected over time) is regarded as an efficiency parameter to evaluate the skill of the operator and to assess the outcome of the procedure. MATERIALS AND METHODS Five surgeons performed TURP using a Gyrus-type bipolar system in 123 patients with BPE/LUTS who came to our observation from June 2016 to December 2019. The amount of irrigation fluid used during the procedure was registered and correlated to the operating time, resection-rate, prostate adenoma weight, post-operative bladder irrigation time, intraoperative bleeding and days of catheterization. RESULTS We found an inverse correlation between the amount of irrigation fluid used during TURP and the resection-rate recorded for all operators, according to Spearman's Correlation (r = -0.78, p = 0.002); a direct correlation was also found between the amount of irrigation fluid and the adenoma weight. Finally, we also found a direct correlation with intraoperative bleeding and the duration and amount of bladder irrigation during and after TURP. CONCLUSIONS The amount of irrigation fluid used is proposed as a reliable parameter to estimate the efficiency of the endoscopic procedure as well to assess the skill of the operator and shortterm results. The observed data encourage the possibility of applying this new efficiency indicator to all endoscopic maneuvers.
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Affiliation(s)
| | - Daniela Biferi
- Mazzini Hospital, Department of Urology, ASL Teramo, Teramo.
| | - Guevar Maselli
- Mazzini Hospital, Department of Urology, ASL Teramo, Teramo.
| | | | | | - Luca Topazio
- Mazzini Hospital, Department of Urology, ASL Teramo, Teramo.
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Luu T, Gonzalez RR. Residency Surgical BPH Training Paradigms from MIST to HOLEP. Curr Urol Rep 2023; 24:261-269. [PMID: 36947390 DOI: 10.1007/s11934-023-01153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW Benign prostatic hyperplasia (BPH) is a common medical condition of older men that often requires medical or surgical therapy. Surgical options for BPH have grown exponentially over the last two decades. The numerous options and/or lack of access to them can make it challenging for new trainees to gain proficiency. We examine the literature for available BPH surgical simulators, learning curves, and training pathways. RECENT FINDINGS Each BPH surgical therapy has a learning curve which must be overcome. There is an abundance of TURP simulators which have shown face, content, and construct validity in the literature. Similarly, laser therapies have validated simulators. Newer technologies do have available simulators, but they have not been validated. There are strategies to improve learning and outcomes, such as having a structured training program. Simulators are available for BPH surgical procedures and some have been implemented in urology residencies. It is likely that such simulation may make urologists more facile on their learning curves for newer technologies. Further studies are needed. Future directions may include integration of simulator technology into training pathways that include surgical observation and proctorship.
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Affiliation(s)
- Thaiphi Luu
- Department of Urology, Scurlock Tower, Houston Methodist Hospital, Suite 2100, 6560 Fannin St, Houston, TX, 77030, USA.
| | - Ricardo R Gonzalez
- Department of Urology, Scurlock Tower, Houston Methodist Hospital, Suite 2100, 6560 Fannin St, Houston, TX, 77030, USA
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Tokas T, Ortner G, Peteinaris A, Somani BK, Herrmann T, Nagele U, Veneziano D, Gözen AS, Kallidonis P. Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology. World J Urol 2021; 40:1091-1110. [PMID: 34800135 DOI: 10.1007/s00345-021-03886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Transurethral resection (TURP) and photoselective vaporization of the prostate (PVP) constitute established surgical options to treat benign prostate hyperplasia. We investigated the current literature for simulators that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum. METHODS A literature search was performed using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL. Search terms included: Simulat*, train*, curricull*, transurethral, TUR*, vaporesect*, laser. The efficacy of different simulators and the impact of different devices, curricula and courses in training and trainee learning curves were the primary endpoints. RESULTS Thirty-one studies are selected and presented. Validated virtual reality TURP simulators are the UW VR, PelvicVision, Uro-Trainer, and TURPsim™. Validated synthetic TURP models are Dr. K. Forke's TURP trainer, Bristol TURP trainer, different tissue prostate models, and 3D-printed phantoms. The Myo Sim PVP and the GreenLightTM are sufficiently validated PVP simulators. Several TURP and PVP training curricula have been developed and judged as applicable. Finally, the TURP modules of the European Urology Residents Education Programme (EUREP) Hands-on Training course and the Urology Simulation Bootcamp Course (USBC) are the most basic annual TURP courses identified in the international literature. CONCLUSIONS Simulators and courses or curricula are valuable learning and training TURP/PVP tools. The existent models seem efficient, are not always adequately evaluated and accepted. As part of training curricula and training courses, the use of training simulators can significantly improve quality for young urologists' education and clinical practice.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria. .,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Thomas Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.,Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | | | - Ali Serdar Gözen
- Department of Urology, SLK Kliniken, Klinikum Heilbronn, Heilbronn, Germany
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Leung DKW, Yuen SKK, Lo KL, Ng CF, Teoh JYC. eLearning and transurethral prostate surgery: virtual tools for a real training. Curr Opin Urol 2021; 31:456-460. [PMID: 34175876 DOI: 10.1097/mou.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the recent two decades, technological breakthrough has tremendously expanded the scope of transurethral prostate surgery. New gadgets and energy devices keep emerging to tackle benign prostatic obstruction, which was dealt with mainly by transurethral resection of prostate in the old days. Although this trend appears fascinating, it also means that urologists need quality training to attain surgical safety in performing these new surgeries. E-learning and simulation training may play an important role in modern urology training. RECENT FINDINGS In this review, we would describe, using up-to-date evidence, the key components of simulation training, the types of simulators currently in use and their respective advantages and limitations. SUMMARY Modern simulation technology enables surgical training in a realistic, reproducible and risk-free environment. Simulation training has been proven to improve both performers' confidence and objective scores in various transurethral prostate surgeries. Its use should therefore be advocated.
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Affiliation(s)
- David Ka-Wai Leung
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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5
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Kozan AA, Chan LH, Biyani CS. Current Status of Simulation Training in Urology: A Non-Systematic Review. Res Rep Urol 2020; 12:111-128. [PMID: 32232016 PMCID: PMC7085342 DOI: 10.2147/rru.s237808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Simulation has emerged as an effective solution to increasing modern constraints in surgical training. It is recognized that a larger proportion of surgical complications occur during the surgeon's initial learning curve. The simulation takes the learning curve out of the operating theatre and facilitates training in a safe and pressure-free environment whilst focusing on patient safety. The cost of simulation is not insignificant and requires commitment in funding, human resources and logistics. It is therefore important for trainers to have evidence when selecting various simulators or devices. Our non-systematic review aims to provide a comprehensive up-to-date picture on urology simulators and the evidence for their validity. It also discusses emerging technologies and future directions. Urologists should embed evidence-based simulation in training programs to shorten learning curves while maintaining patient safety and work should be directed toward a validated and agreed curriculum.
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Affiliation(s)
- Andrei Adrian Kozan
- Department of Urology, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Luke Huiming Chan
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Chandra Shekhar Biyani
- Department of Urology, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
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Rasyid N, Putra HWK, Birowo P, Wahyudi I, Mochtar CA, Hamid ARAH. TUR-P phantom for resident surgical training: food-based design as a human mimicking model of the prostate. World J Urol 2020; 38:2907-2914. [PMID: 32020273 DOI: 10.1007/s00345-020-03085-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study would like to develop a novel model similar to human prostate in terms of its texture profile, sensation upon resection, and anatomical hallmarks for resident transurethral resection of the prostate (TUR-P) training. METHODS Ten phantom designs were proposed, using broadly available ingredients and a homemade protocol. Three steps of evaluation and development were done: objective measurement measuring texture profile (e.g. hardness, elasticity, cohesiveness/consistency, and adhesiveness/stickiness) using TA-XT2i Texture Analyzer (Llyod Instruments, Ametek Inc) to compare the designs with human prostate, finding the most similar design to prostate; expert consensus by a panel of urologist/senior residents comparing the simulation of TUR-P on the selected design with pre-existing control phantom; and anatomical design development using 3D printing for molding. RESULTS Texture profile analysis for mean hardness, elasticity, cohesiveness/consistency, and adhesiveness/stickiness of human prostate was 3753.4 ± 673.4, 85 ± 1.9, 0.7 ± 0.03, and 0, respectively, and design IX was the most similar to human prostate (3660.7 ± 465.6, 87.0 ± 2.5, 0.6 ± 0.05, 0). Furthermore, expert consensus showed superiority of design IX compared with pre-existing control phantom (16.95 ± 1.36 vs 8.86 ± 3.10; P < 0.001). Most of the respondents agreed that the texture, consistency, and phantom ability to mimic human prostate upon resection were similar with human prostate, though hallmarks of the prostate e.g. veromontanum, and lobes were lacking. We used these feedbacks to develop a mold, designed to produce these important anatomical hallmarks. CONCLUSION This study developed a cost-effective prostate model from a food-based design that is similar to human prostate in terms of its texture and sensation upon TUR-P resection provided with important anatomical hallmarks.
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Affiliation(s)
- Nur Rasyid
- Department of Urology, Cipto Mangunkusumo General Hospital-Universitas Indonesia, Jl. Diponegoro 71, Senen, Central Jakarta, DKI Jakarta, 10430, Indonesia
| | - Harun Wijanarko Kusumo Putra
- Department of Urology, Cipto Mangunkusumo General Hospital-Universitas Indonesia, Jl. Diponegoro 71, Senen, Central Jakarta, DKI Jakarta, 10430, Indonesia
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital-Universitas Indonesia, Jl. Diponegoro 71, Senen, Central Jakarta, DKI Jakarta, 10430, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Cipto Mangunkusumo General Hospital-Universitas Indonesia, Jl. Diponegoro 71, Senen, Central Jakarta, DKI Jakarta, 10430, Indonesia
| | - Chaidir Arif Mochtar
- Department of Urology, Cipto Mangunkusumo General Hospital-Universitas Indonesia, Jl. Diponegoro 71, Senen, Central Jakarta, DKI Jakarta, 10430, Indonesia
| | - Agus Rizal A H Hamid
- Department of Urology, Cipto Mangunkusumo General Hospital-Universitas Indonesia, Jl. Diponegoro 71, Senen, Central Jakarta, DKI Jakarta, 10430, Indonesia.
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8
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Boutefnouchet T, Laios T. Transfer of arthroscopic skills from computer simulation training to the operating theatre: a review of evidence from two randomised controlled studies. SICOT J 2016; 2:4. [PMID: 27163093 PMCID: PMC4849227 DOI: 10.1051/sicotj/2015039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: There is paucity in the research on transfer validity of arthroscopic simulator training. The aim of this article is to determine whether skills derived from arthroscopic simulation are transferrable to the operating theatre and retained over time. Methods: A systematic review with rigorous criteria to identify the highest level of evidence available was carried out. The studies were critically appraised with narrative data synthesis. Results: Twenty-one studies on arthroscopic simulation were identified. Only two studies were randomised controlled trials. The first article demonstrated improved performance of basic knee arthroscopic tasks following a fixed period of training. The second article showed improved performance of arthroscopic tasks and no deterioration in the levels of skills following a period of six months. In addition, the two studies succeeded in demonstrating the importance of 3D motion analysis using computer simulators in the assessment of technical skills. Components of evaluation such as time to task completion, distance travelled by instruments and incidence of instruments collisions were associated with the highest validity and reliability of assessment. This systematic review highlighted the limitations of these two randomised studies. Discussion: Evidence from the two trials suggests that knee arthroscopy simulator training can result in improved performance. This review helped highlight the contribution of the two studies in terms of internal validity and consistency of using arthroscopic skills training. Further level I studies are however required to demonstrate the evidence for transfer and predictive validity of computer simulation as a training instrument.
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Affiliation(s)
- Tarek Boutefnouchet
- University Hospital Coventry and Warwickshire Clifford Bridge Road Walsgrave, Coventry CV2 2DX UK ; Warwick Medical School, The University of Warwick Coventry CV4 7AL UK
| | - Thomas Laios
- Department of Trauma and Orthopaedic Surgery, Heart of England NHS Foundation Trust, Heartlands Hospital Bordesley Green East Birmingham B9 5SS UK
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Khan R, Aydin A, Khan MS, Dasgupta P, Ahmed K. Simulation-based training for prostate surgery. BJU Int 2015; 116:665-74. [DOI: 10.1111/bju.12721] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Raheej Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation; King's College London; Department of Urology; Guy's Hospital; King's Health Partners; London UK
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Aydin A, Muir GH, Graziano ME, Khan MS, Dasgupta P, Ahmed K. Validation of the GreenLight™ Simulator and development of a training curriculum for photoselective vaporisation of the prostate. BJU Int 2014; 115:994-1003. [DOI: 10.1111/bju.12842] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abdullatif Aydin
- MRC Centre for Transplantation; King's College London and Department of Urology; Guy's and St. Thomas' NHS Foundation Trust; King's Health Partners; King's College Hospital; London UK
| | - Gordon H. Muir
- Department of Urology; King's College Hospital; London UK
| | | | - Muhammad Shamim Khan
- MRC Centre for Transplantation; King's College London and Department of Urology; Guy's and St. Thomas' NHS Foundation Trust; King's Health Partners; King's College Hospital; London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation; King's College London and Department of Urology; Guy's and St. Thomas' NHS Foundation Trust; King's Health Partners; King's College Hospital; London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation; King's College London and Department of Urology; Guy's and St. Thomas' NHS Foundation Trust; King's Health Partners; King's College Hospital; London UK
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Evaluation of the Educational Value of a Virtual Reality TURP Simulator According to a Curriculum-based Approach. Simul Healthc 2014; 9:288-94. [DOI: 10.1097/sih.0000000000000041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brewin J, Ahmed K, Khan MS, Jaye P, Dasgupta P. Face, content, and construct validation of the Bristol TURP trainer. JOURNAL OF SURGICAL EDUCATION 2014; 71:500-5. [PMID: 24776866 DOI: 10.1016/j.jsurg.2014.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/30/2013] [Accepted: 01/20/2014] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Validation studies are an important part of simulator evaluation and are considered necessary to establish the effectiveness of simulation-based training. The widely used Bristol transurethral resection of prostate (TURP) simulator has not been formally validated. OBJECTIVES Evaluation of the face, content, and construct validities of the Bristol TURP simulator as an endourology training tool. DESIGN Using established validation methodology, face, content, and construct validities were evaluated. Face and content validities were assessed using a structured quantitative survey. Construct validity was assessed by comparing the performance of experts and novices using a validated performance scale and resection efficiency. PARTICIPANTS AND SETTING Overall, 8 novice urologists and 8 expert urologists participated in the study. The study was conducted in a dedicated surgical simulation training facility. RESULTS All 16 participants felt the model was a good training tool and should be used as an essential part of urology training (face validity). Content validity evaluation showed that most aspects of the simulator were adequately realistic (mean Likert scores 3.38-3.57/5); however, the model does not simulate bleeding. Experts significantly outperformed novices (p < 0.001) across all measures of performance, therefore establishing construct validity. CONCLUSIONS The Bristol TURP simulator shows face, content, and construct validities, although some aspects of the simulator were not very realistic (e.g., bleeding). This study provides evidence for the continuing use of this simulator in endourology training.
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Affiliation(s)
- James Brewin
- Kings Health Partners, Guy's Kings and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Kamran Ahmed
- Kings Health Partners, Guy's Kings and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Muhammed S Khan
- Kings Health Partners, Guy's Kings and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Peter Jaye
- Kings Health Partners, Guy's Kings and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Prokar Dasgupta
- Kings Health Partners, Guy's Kings and St Thomas' NHS Foundation Trust, London, United Kingdom
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Källström R, Hjertberg H, Svanvik J. Impact of Virtual Reality-Simulated Training on Urology Residents' Performance of Transurethral Resection of the Prostate. J Endourol 2010; 24:1521-8. [DOI: 10.1089/end.2009.0667] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Reidar Källström
- Department of Urology, University Hospital Linköping, Linköping, Sweden
| | - Hans Hjertberg
- Department of Urology, Vrinnevi Hospital Norrköping, Norrköping, Sweden
| | - Joar Svanvik
- Department of Surgery, University Hospital Linköping, Linköping, Sweden
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Källström R, Hjertberg H, Svanvik J. Construct Validity of a Full Procedure, Virtual Reality, Real-Time, Simulation Model for Training in Transurethral Resection of the Prostate. J Endourol 2010; 24:109-15. [DOI: 10.1089/end.2009.0114] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hans Hjertberg
- Department of Urology, Vrinnevi Hospital, Norrköping, Sweden
| | - Joar Svanvik
- Department of Surgery, University Hospital, Linköping, Sweden
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Schout BMA, Hendrikx AJM, Scheele F, Bemelmans BLH, Scherpbier AJJA. Validation and implementation of surgical simulators: a critical review of present, past, and future. Surg Endosc 2009; 24:536-46. [PMID: 19633886 PMCID: PMC2821618 DOI: 10.1007/s00464-009-0634-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 05/31/2009] [Accepted: 06/26/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the past 20 years the surgical simulator market has seen substantial growth. Simulators are useful for teaching surgical skills effectively and with minimal harm and discomfort to patients. Before a simulator can be integrated into an educational program, it is recommended that its validity be determined. This study aims to provide a critical review of the literature and the main experiences and efforts relating to the validation of simulators during the last two decades. METHODS Subjective and objective validity studies between 1980 and 2008 were identified by searches in Pubmed, Cochrane, and Web of Science. RESULTS Although several papers have described definitions of various subjective types of validity, the literature does not offer any general guidelines concerning methods, settings, and data interpretation. Objective validation studies on endourological simulators were mainly characterized by a large variety of methods and parameters used to assess validity and in the definition and identification of expert and novice levels of performance. CONCLUSION Validity research is hampered by a paucity of widely accepted definitions and measurement methods of validity. It would be helpful to those considering the use of simulators in training programs if there were consensus on guidelines for validating surgical simulators and the development of training programs. Before undertaking a study to validate a simulator, researchers would be well advised to conduct a training needs analysis (TNA) to evaluate the existing need for training and to determine program requirements in a training program design (TPD), methods that are also used by designers of military simulation programs. Development and validation of training models should be based on a multidisciplinary approach involving specialists (teachers), residents (learners), educationalists (teaching the teachers), and industrial designers (providers of teaching facilities). In addition to technical skills, attention should be paid to contextual, interpersonal, and task-related factors.
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Affiliation(s)
- B M A Schout
- Department of Urology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
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Bach T, Geavlete B, Herrmann TRW, Gross AJ. "Homemade" TUR-simulator for less than $40 U.S.? The "Tupper" experience. J Endourol 2009; 23:509-13. [PMID: 19245301 DOI: 10.1089/end.2008.0186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Transurethral surgery is important in daily urologic life. In training residents it is important to develop resection skills. We introduce a homemade simulator to improve capabilities for the training of transurethral procedures. MATERIALS AND METHODS Material consists of 7 cm of a 30F garden hose, a suprapubic tube, a Tupperware box (Frankfurt, Germany), three catheter plugs, and silicone gel. Cost of materials is below $40 U.S. Transurethral procedures such as mono- and bipolar resection and RevoLix laser vaporesection were carried out. Different meat types were tested to develop a close to real resection feeling. Further, flexible cystoscopy was trained with the simulator. Multiple markings were placed inside the box. These markings had to be identified by flexible cystoscopy. The time to completion of this task was recorded. RESULTS Transurethral resection and flexible cystoscopy is feasible. Pork and beef lead to a realistic feeling compared with transurethral resection. For laser surgery, pork and chicken seem to be most realistic. Further, confidence in flexible cystoscopy could be obtained. During the flexible cystoscopy task, an average time reduction of 50.96% could be achieved. CONCLUSION This cheap and simple resection simulator allows easy training of lower urinary tract procedures. It helps young urologists to acquire basic endourologic skills. It may be beneficial for residents in the process of learning lower urinary tract surgery. Further, new techniques can be trained and may lead to a decreased risk for the patients.
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Affiliation(s)
- Thorsten Bach
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany.
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Schout BMA, Bemelmans BLH, Martens EJ, Scherpbier AJJA, Hendrikx AJM. How useful and realistic is the uro trainer for training transurethral prostate and bladder tumor resection procedures? J Urol 2009; 181:1297-303; discussion 1303. [PMID: 19152928 DOI: 10.1016/j.juro.2008.10.169] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Indexed: 11/15/2022]
Abstract
PURPOSE We evaluated the face and content validity (novice and expert opinions of realism and usefulness) of the Uro Trainer (Karl Storz GmbH, Tuttlingen, Germany), a simulator for transurethral resection procedures, to ascertain whether it is justifiable to continue the validation process by performing prospective experimental studies. MATERIALS AND METHODS Between 2006 and 2008, 104 urologists and urology residents performed a transurethral bladder tumor resection and/or transurethral prostate resection procedure on the Uro Trainer, and rated simulator usefulness and realism on a 10-point scale (1-not at all useful/realistic/poor, 10-very useful/realistic/excellent). Participants were classified as experts (more than 50 procedures performed) or novices (50 or fewer procedures performed). Because the literature offered no guidelines for interpreting our data, we used criteria from other studies to interpret the results. RESULTS A total of 161 questionnaires were analyzed from 97 (21% experts, 79% novices) and 64 (30% experts, 70% novices) participants who performed transurethral prostate resection and transurethral bladder tumor resection procedures, respectively. Mean usefulness, realism and overall scores varied from 5.6 to 8.2 (SD 1.4-2.5). Measured by validity criteria from other studies, Uro Trainer face and content validity was unsatisfactory, with ratings on only 3%, 5% and 8% of the parameters interpreted as positive, moderately acceptable and good, respectively. CONCLUSIONS Measured against criteria from other validation studies, Uro Trainer face and content validity appears to be unsatisfactory. Modification of the simulator seems advisable before further experimental validation studies are initiated. The lack of general guidelines for establishing face and content validity suggests a need for consensus about appropriate methods for evaluating the validity of simulators.
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Affiliation(s)
- Barbara M A Schout
- Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Wexner SD, Bergamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH, John H. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 2008; 23:438-43. [PMID: 19037694 DOI: 10.1007/s00464-008-0202-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 10/13/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing wristed laparoscopic instruments. METHODS At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic surgery in pelvic operations surgery for malignancy including prostate, rectal, uterine, and cervical carcinoma. All members of the interdisciplinary panel were asked to define the role of robotic surgery in prostate, rectal, and uterine carcinoma. All key statements were reformulated until a consensus within the group was achieved (Murphy et al., Health Technol Assess 2(i-v):1-88, 1998). For the systematic review, a comprehensive literature search was performed in Medline and the Cochrane Library from January 1997 to June 2007. The keywords used were Da Vinci, telemonitoring, laparoscopy, neoplasms for urology, colorectal, gynecology, visceral surgery, and minimally invasive surgery. The pelvic surgery meeting was supported by Olympus Medical Systems Europa. RESULTS As of December 31, 2007, there were 795 unit shipments worldwide of the Da Vinci((R)): 595 in North America, 136 in Europe, and 64 in the rest of the world (http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324 ). It was estimated that, during 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci robot system in the USA, reflecting market penetration of 60% of radical prostatectomies in the USA. This utilization represents 50% growth as in 2006 only 42% of all radical prostatectomies performed in the USA employed robotics. CONCLUSION While robotic prostatectomy has become the most widely accepted method of prostatectomy, robotic hysterectomy and proctectomy remain far less widely accepted. The theoretical benefits of the increased degrees of freedom and three-dimensional visualization may be outweighed in these areas by the loss of haptic feedback, increased operative times, and increased cost.
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Affiliation(s)
- Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
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Schout BMA, Hendrikx AJM, Scherpbier AJJA, Bemelmans BLH. Update on training models in endourology: a qualitative systematic review of the literature between January 1980 and April 2008. Eur Urol 2008; 54:1247-61. [PMID: 18597924 DOI: 10.1016/j.eururo.2008.06.036] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 06/12/2008] [Indexed: 01/06/2023]
Abstract
CONTEXT Interest in the use of simulators in urological skills training is on the increase. To ensure effective implementation of training models, an overview of the nature and validity of the available models is of the essence. OBJECTIVE To obtain an overview of training models and their validity by performing a qualitative systematic review of the literature. EVIDENCE ACQUISITION Studies were identified through searches of PubMed, the Cochrane Library, and Web of Science between January 1980 and April 2008 using two search strategies: "urology and (training or simulat or model)" and combinations of these terms with "prostate," "kidney," "bladder," or "ureter." Studies were included if they (1) described one or more training models, and/or (2) examined the validity of training models. Studies in undergraduate education and of training models for physical examination were excluded. Validation studies were scored according to Kirkpatrick and Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence. EVIDENCE SYNTHESIS Forty-five articles (out of the initial list of 4753 retrieved articles, 0.9%) were included, describing 30 types of training models and 54 validation studies. The largest number of models has been described for ureterorenoscopy (nine types). Only three randomised controlled trials (RCTs), receiving a 1b OCEBM level of evidence score, were found. Studies investigating the impact of simulator training on performance in patients (criterion B validity) were scarce. The number of participants in experimental studies ranged from 7 to 136. CONCLUSIONS Due to growing interest in training models in urology, it is increasingly urgent to determine which of these models are most valuable for postgraduate training. Because the validation studies published so far are few in number, have low evidence levels, and are composed of only a few RCTs, it is important that more randomised controlled validation studies including larger numbers of participants are performed.
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Affiliation(s)
- Barbara M A Schout
- Catharina Hospital Eindhoven, Eindhoven, The Netherlands; VU Medical Centre Amsterdam, Amsterdam, The Netherlands.
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Cury J, Coelho RF, Bruschini H, Srougi M. Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience? Clinics (Sao Paulo) 2008; 63:315-20. [PMID: 18568239 PMCID: PMC2664229 DOI: 10.1590/s1807-59322008000300005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 02/18/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6%) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.
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Affiliation(s)
- José Cury
- Department of Urology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Wignall GR, Denstedt JD, Preminger GM, Cadeddu JA, Pearle MS, Sweet RM, McDougall EM. Surgical simulation: a urological perspective. J Urol 2008; 179:1690-9. [PMID: 18343441 DOI: 10.1016/j.juro.2008.01.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE Surgical education is changing rapidly as several factors including budget constraints and medicolegal concerns limit opportunities for urological trainees. New methods of skills training such as low fidelity bench trainers and virtual reality simulators offer new avenues for surgical education. In addition, surgical simulation has the potential to allow practicing surgeons to develop new skills and maintain those they already possess. We provide a review of the background, current status and future directions of surgical simulators as they pertain to urology. MATERIALS AND METHODS We performed a literature review and an overview of surgical simulation in urology. RESULTS Surgical simulators are in various stages of development and validation. Several simulators have undergone extensive validation studies and are in use in surgical curricula. While virtual reality simulators offer the potential to more closely mimic reality and present entire operations, low fidelity simulators remain useful in skills training, particularly for novices and junior trainees. Surgical simulation remains in its infancy. However, the potential to shorten learning curves for difficult techniques and practice surgery without risk to patients continues to drive the development of increasingly more advanced and realistic models. CONCLUSIONS Surgical simulation is an exciting area of surgical education. The future is bright as advancements in computing and graphical capabilities offer new innovations in simulator technology. Simulators must continue to undergo rigorous validation studies to ensure that time spent by trainees on bench trainers and virtual reality simulators will translate into improved surgical skills in the operating room.
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Affiliation(s)
- Geoffrey R Wignall
- Division of Urology, University of Western Ontario, London, Ontario, Canada
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Abstract
Performance of transurethral resection of the prostate and bladder involves the ability to work in a small three-dimensional space while receiving two-dimensional visual feedback. The operation also demands adept psychomotor abilities, as one has to navigate the resectoscope and the loop continuously and simultaneously while managing the electrical current with the use of both hands and a foot pedal. The fact that the procedure is performed in a fluid environment and that the field often is obscured is an important factor to consider when creating a teaching tool, as the debris and blood can be disorienting to the resectionist in training. Historically, this training problem was addressed with sheer case volume, but the number of procedures performed during a residency has declined. Limbs and Things (Bristol, UK) created a synthetic "physical" disposable model of the prostate that allows the user to practice basic cutting skills. No usability or validation studies have been published on this model. Several virtual-reality (VR) TURP simulators have been described, with varying degrees of preliminary validation studies. The University of Washington VR TURP Trainer is licensed to Medical Education Technologies, Inc. (METI, Sarasota, FL). A force-feedback device has been integrated. The simulator has an integrated curriculum with subtask exercises, such as navigation, cutting, coagulation, and full resection modules. It logs motion and force data, as well as operative errors, grams of tissue resected, blood loss, irrigant volume, foot pedal use, and differential time spent with orientation, cutting, or coagulation. An AHRQ-funded multi-institutional predictive validity study is in progress, examining this simulator's ability to improve residents' performance in the operating room.
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Affiliation(s)
- Robert M Sweet
- Department of Urologic Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota 55455, USA.
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Rashid HH, Kowalewski T, Oppenheimer P, Ooms A, Krieger JN, Sweet RM. The Virtual Reality Transurethral Prostatic Resection Trainer: Evaluation of Discriminate Validity. J Urol 2007; 177:2283-6. [PMID: 17509340 DOI: 10.1016/j.juro.2007.01.120] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To understand how urologists acquire resection skills we analyzed factors correlating with favorable resection metrics in groups defined as experts, residents and novices. We then evaluated discriminate validity by determining factors correlating with proficiency among individuals in the expert, resident and novice groups. MATERIALS AND METHODS A total of 136 subjects completed the protocol, including 72 urologists, 45 residents and 19 novices. After a pre-task questionnaire and training video subjects performed a standardized 5-minute resection task. Primary metrics were gm resected, blood loss, irrigant volume used, foot pedal use and differential time spent with orientation, cutting or coagulation. RESULTS Among experts larger resection correlated with more time spent cutting (p <0.001). In contrast, increased coagulation time correlated with gm resected in the novice group (p = 0.001). The number of transurethral prostate resections that residents reported having done in the real operating room correlated with gm resected (p = 0.043), use of more irrigating fluid (p = 0.024) and less time spent coagulating (p = 0.027) on the simulator. In residents and experts exclusively primary resection efficiency metrics, fluid use and blood loss correlated with cuts at tissue and correlated inversely with coagulation and orientation time (p <0.05). CONCLUSIONS Different factors determine transurethral prostate resection performance metrics among experts, residents and novices. These correlations reinforce discriminate validity and provide insight into specific factors that likely determine success at different training levels. Such data could be used to isolate and train skill subsets in the curriculum and they may elucidate the safest and most efficient approach to train resection skills.
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Affiliation(s)
- Hani H Rashid
- Department of Urological Surgery, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Gomoll AH, O'Toole RV, Czarnecki J, Warner JJP. Surgical experience correlates with performance on a virtual reality simulator for shoulder arthroscopy. Am J Sports Med 2007; 35:883-8. [PMID: 17261572 DOI: 10.1177/0363546506296521] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The traditional process of surgical education is being increasingly challenged by economic constraints and concerns about patient safety. Sophisticated computer-based devices have become available to simulate the surgical experience in a protected environment. As with any new educational tool, these devices have generated controversy about the validity of the training experience. HYPOTHESIS Performance on a virtual reality simulator correlates with actual surgical experience. STUDY DESIGN Controlled laboratory study. METHODS Forty-three test subjects of various experience levels in shoulder arthroscopy were tested on an arthroscopy simulator according to a standardized protocol. Subjects were evaluated for time to completion, distance traveled with the tip of the simulated probe compared with a computer-determined optimal distance, average probe velocity, and number of probe collisions with the tissues. RESULTS Subjects were grouped according to prior experience with shoulder arthroscopy. Comparing the least experienced with most experienced groups, the average time to completion decreased by 62% from 128.8 seconds to 49.2 seconds; path length and hook collisions were more than halved from 8.2 to 3.8 and 34.1 to 16.8, respectively; and average probe velocity more than doubled from 0.18 to 0.4 cm/second. There were no significant differences for any parameter tested between subjects with video game experience compared to those without. CONCLUSIONS The study demonstrated a close and statistically significant correlation between simulator results and surgical experience, thus confirming the hypothesis. Conversely, experience with video games was not associated with improved simulator performance. This indicates that the skill set tested may be similar to the one developed in the operating room, thus suggesting its use as a potential tool for future evaluation of surgical trainees. CLINICAL RELEVANCE The results have implications for the future of orthopaedic surgical training programs, the majority of which have not embraced virtual reality technology for physician education.
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Affiliation(s)
- Andreas H Gomoll
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
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Current World Literature. Curr Opin Urol 2007; 17:77-81. [PMID: 17143115 DOI: 10.1097/mou.0b013e328012cbca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodríguez-Covarrubias F, Martínez Liévano L, Gabilondo Pliego B, Gabilondo Navarro F, Atisha-Fregoso Y, Arroyo C. [Use of a virtual immersion computer simulator as a model for basic training in laparoscopic urology]. Actas Urol Esp 2006; 30:819-23. [PMID: 17078579 DOI: 10.1016/s0210-4806(06)73539-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND to date, it has not been defined the best method for teaching urologic laparoscopy, however it is well recognized that it involves a steep learning curve. METHODS A course of Laparoscopic Urology was done in our Institute. The program included skill practices in a virtual immersion simulator which evaluated, the score and time to complete each activity. This was done in a group of residents with previous experience with this virtual simulator (group 1) and another group of residents with no experience (group 2). Four different basic tasks were performed in the virtual simulator, which included: coordination, cutting, clip application and performing a simple suture. RESULTS When we compared the scores between both groups the mean scores for each task were superior in group 1 compared to the group 2, with no statistically significant difference, however when we compared the time to complete each task, it was shorter in group 1 compared to group 2 with a statistically significant difference. CONCLUSIONS The performance of residents without experience in a virtual simulator was similar to that of previously trained residents, however it takes less time to complete each task as the resident gains experience in these simulators. The use of virtual simulators for laparoscopy training are useful when learning basic techniques allowing the surgeon to improve hand dexterity and coordination in laparoscopic surgery.
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Affiliation(s)
- F Rodríguez-Covarrubias
- Departamento de Urología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
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Hoznek A, Salomon L, de la Taille A, Yiou R, Vordos D, Larre S, Abbou CC. Simulation training in video-assisted urologic surgery. Curr Urol Rep 2006; 7:107-13. [PMID: 16526994 DOI: 10.1007/s11934-006-0068-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The current system of surgical education is facing many challenges in terms of time efficiency, costs, and patient safety. Training using simulation is an emerging area, mostly based on the experience of other high-risk professions like aviation. The goal of simulation-based training in surgery is to develop not only technical but team skills. This learning environment is stress-free and safe, allows standardization and tailoring of training, and also objectively evaluate performances. The development of simulation training is straightforward in endourology, since these procedures are video-assisted and the low degree of freedom of the instruments is easily replicated. On the other hand, these interventions necessitate a long learning curve, training in the operative room is especially costly and risky. Many models are already in use or under development in all fields of video-assisted urologic surgery: ureteroscopy, percutaneous surgery, transurethral resection of the prostate, and laparoscopy. Although bench models are essential, simulation increasingly benefits from the achievements and development of computer technology. Still in its infancy, virtual reality simulation will certainly belong to tomorrow's teaching tools.
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Affiliation(s)
- András Hoznek
- Service d'Urologie, Centre Hospitalier Universitaire Henri Mondor, Université Paris XII, 51. Av;du Ml. De Lattre de Tassigny, 94010 Créteil-cedex, France.
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