New Advanced Bench Model for Flexible Ureteroscopic Training: The Smart Simulator

Simulation-Based Training Models for Urolithiasis: A Systematic Review

Objectives: Urolithiasis is one of the most common presentations in urological practice and it is becoming increasingly important to provide structured, simulation-based training using validated training models. This systematic review aims to identify current simulation-based training models and to evaluate their validity and effectiveness. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was performed on the Medline and EMBASE databases for English language articles published between 2000 and 2018 describing and/or assessing validity of simulation models for urolithiasis procedures. Studies were qualitatively assessed for validity using the Messick validity framework and models were assigned levels of recommendation using the McGaghie model of translational outcomes. Results: A total of 98 studies were included in this study assessing 51 models, with 28 studies concerning models for urethrocystoscopy, 46 studies for ureterorenoscopy, and 39 studies for percutaneous access and/or nephrolithotomy. Only four models demonstrated a level of recommendation of 4. The most validated models were the URO/PERC-Mentor (Simbionix, Lod, Israel) with multiple studies for each across various procedural skills. Conclusion: There is a wide spectrum of simulation-based models currently available for urolithiasis procedures, mostly with limited validity evidence from small studies. Further research is required with higher levels of evidence including randomized controlled trials. In addition, long-term transfer of skills to the operating room should be assessed to establish whether there is genuine skill development and retention using simulation models and whether this helps to reduce surgical complications.

Retrograde intrarenal surgery: Past, present, and future

With the recent technological advancements in endourology, retrograde intrarenal surgery has become a more popular procedure for treatment of urolithiasis. Furthermore, since the introduction of new laser systems and advanced flexible ureteroscopy with miniaturized ureteroscopes, the treatment indications for retrograde intrarenal surgery have expanded to include not only larger renal stones of >2 cm but also upper urinary tract urothelial carcinoma, ureteral stricture, and idiopathic renal hematuria. Clinicians must keep up with these trends and make good use of these technologies in the rapidly changing field of endourology. Simultaneously, we must consider the risk of various complications including thermal injury due to laser use, ureteral injury caused by the ureteral access sheath, and radiation exposure during retrograde intrarenal surgery with fluoroscopic guidance. This review focuses on the past, present, and future of retrograde intrarenal surgery and provides many topics and clinical options for urologists to consider.

Performance Optimization Strategies for Complex Endourologic Procedures

OBJECTIVE

To identify and address factors that may impact a surgeon's performance during endourologic procedures.

METHODS

A literature review was performed for articles focusing on surgical ergonomics, education, sports and performance psychology.

RESULTS

As urologists and trainees have become more comfortable approaching complex pathology endoscopically, there remains an opportunity to refine surgeon-related factors and optimize extrinsic factors to maximize efficiency and provide patients with the highest quality outcomes and safety.

CONCLUSION

Medical centers and training programs should strive to include formal lessons on stress-coping mechanisms, communication, and dedicated ergonomic training, as these all play a role in physician well-being and may lead to improved clinical outcomes.

Novel Education and Simulation Tools in Urologic Training

PURPOSE OF REVIEW

Postgraduate medical training has evolved considerably from an emphasis on hands-on, autonomous learning to a paradigm where simulation technologies are used to introduce and augment certain skill sets. This review is intended to provide an update on surgical simulators and tools for urological trainee education.

RECENT FINDINGS

We provide an overview of simulation platforms for robotics, endoscopy, and laparoscopic practice and training. In general, these simulators provide face, content, and construct validity. Various educational and evaluation tools have been adopted. Simulation platforms have been developed for technical and non-technical surgical skills, educational bootcamps, and tools for evaluation and feedback. While trainees find the opportunity to practice their skills beneficial, there may be difficulty with access due to cost and availability. Additionally, there is a need for more objective metrics demonstrating improvement in skill or patient outcome.

Development of a photographic handbook to improve cystoscopy findings during resident's training: A randomised prospective study

Objectives: To evaluate if the use of a photographic handbook (PH) can be a useful tool to improve the detection of disorders during cystoscopy training, as several hands-on tools have been proposed to improve technical skills but very few aim to improve specificity and sensitivity.

Subjects and methods: Eight junior residents (JRs) were divided into two groups: Group A, comprised four JRs with previous limited experience of performing cystoscopies; and Group B, including four inexperienced JRs who were asked to study a specific PH before performing cystoscopies. The findings of the two groups were compared using the chi-squared test.

Results: A total of 401 consecutive cystoscopies, of which 214 (53.4%) were performed by Group A and 187 (46.6%) by Group B, were considered. Group B showed superior ability in detecting uncommon findings (i.e., carcinoma in situ, bullous oedema, interstitial cystitis, etc.) with 24/46 (52.2%) detected vs eight of 32 (25%) in Group A (P = 0.016).

Conclusions: The PH was a useful tool for improving identification of pathological conditions, which could be used to enhance hands-on simulator and practical tutored training.

Abbreviations: CIS: carcinoma in situ; JR: junior resident; PH: photographic handbook; VR: virtual reality Classification: Stones/Endourology