Simulation-based education in urology - an update

European basic laparoscopic urological skills: a feasibility study in a setting for robot-assisted surgery

Introduction

Since the introduction of laparoscopy, a variety of training sets and tasks have been introduced for surgical education of minimally-invasive surgery. The implementation of the European Basic Laparoscopic Urological Skills into the training and education program of future laparoscopic surgeons created a new era and provided a standardized approach for urological surgical training. However, these tasks have not yet been evaluated in a setting of robot-assisted surgery. The aim of this study is to evaluate the feasibility of the implementation of the four E-BLUS tasks into training modules of robot-assisted surgery.

Methods

A cohort of 31 robotic surgeons (group A: experienced, group B: novices) performed these tasks in two different institutions by using the latest generation of robotic surgical platforms. Time performance and failure rate were assessed and statistically analyzed.

Results

The groups demonstrated a statistically significant difference regarding time performance in half of the tasks involving fine surgical skills (cutting and knotting, p = 0.01 and p = 0.02, respectively) but no significant difference in tasks involving manual ambidexterity (p = 0.14 and 0.12, respectively). A low failure rate during the attempts of the group of novice robotic surgeons could be observed.

Discussion

The use of the E-BLUS tasks in a training setting of robot-assisted surgery is feasible and can lead to the development of surgical skills needed during robot-assisted surgical procedures. It is a relatively low-cost dry lab option for the introduction of novice robotic surgeons.

Development of the European Laparoscopic Intermediate Urological Skills LUSs2 Curriculum: A Delphi Consensus from the European School of Urology

Background and objective

While programmes such as the European Basic Laparoscopic Urological Skills have made strides in foundational training, a significant gap exists for intermediate and advanced laparoscopy education. Our objective is to develop and validate the European laparoscopic intermediate urological skills (LUSs2) curriculum, which will establish uniformity in the training of urological laparoscopic procedures and facilitate proficiency among practitioners.

Methods

The study combines a literature review, cognitive task analysis development by a steering group, and a two-round Delphi survey involving international experts in urological laparoscopy. Consensus was defined as agreement of ≥70% among experts. The survey included statements on various laparoscopic procedures, assessed on a Likert scale from 1 (strongly disagree) to 9 (strongly agree).

Key findings and limitations

The Delphi process achieved consensus on 85% (235/275) of statements, indicating a strong agreement on the curriculum's content. Areas covered include renal hilum dissection, major vessel injury management, enucleation and renorrhaphy, vesicourethral anastomosis, and pyeloplasty. Limitations include the nonsystematic nature of the literature review and potential biases inherent in expert-based consensus methods.

Conclusions and clinical implications

The LUSs2 curriculum significantly advances the standardised training of laparoscopic urological skills. It offers a detailed, consensus-validated framework that addresses the need for uniformity in surgical education and aims to enhance surgical proficiency and patient care.

Patient summary

This study presents the development of a new standardised training curriculum for urological laparoscopic surgery. We intend this curriculum to improve the quality of surgical training and ensure high-quality patient care.

A needs assessment for simulation-based training in emergency urological skills in Ethiopia

BACKGROUND

Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia.

METHODS

This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media.

RESULTS

One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene.

CONCLUSION

Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

Creation and evaluation of a three-dimensional-printed synthetic vas deferens for microsurgical training

Introduction

Individuals choose to undergo vasectomy reversal for a variety of reasons, including remarriage or due to the death of a child. To be proficient in this procedure, the surgeons need to be high volume and the trainees require a safe environment to develop their microsurgical skills. To overcome this challenge, we used three-dimensional (3D) printing to create a synthetic model of the vas deferens with properties similar to the human vas deferens. We distributed this model to experienced microsurgeons for evaluation.

Methods

The vas deferens model was created using thermoplastic polyurethane filament. The filament was then infused with a foaming agent to allow for temperature-dependent tuning of the material's stiffness. The model's outer diameter was 1 mm and the inner lumen was 0.5 mm. Fellowship-trained male reproductive urologists were recruited from the Society for the Study of Male Reproduction website. They used our model and judged it on several factors by completing a 13-question survey.

Results

We received completed evaluations from five microsurgeons. Eighty percent of the surgeons were able to complete a full anastomosis on the model using 9-0 and 10-0 sutures. The majority of the completed anastomoses were performed using the one-layer technique. The average responses for the model's usefulness as a practice tool, a training tool, and overall assessment ranged from 72 to 79 out of 100. Comments for the improvement included the need for a more flexible and softer model.

Conclusions

We created a 3D-printed synthetic vas deferens that serves as a valuable training and practice tool.

Validation of A 3D-printed simulator for training in endoscopic injection of bulking agent for vesicoureteral reflux: a pilot study

BACKGROUND

Simulation-based training plays a significant role in surgical education, especially in minimally invasive pediatric surgery and urology. This study aimed to evaluate a novel 3D-printed model as training tool for endoscopic injection of bulking agent.

METHODS

Forty-three attendees and ten teaching faculty members were invited to complete a post hoc questionnaire after completing training sessions using the Fish Tank Simulation Model (FTSM). The survey consisted of a 7-question 5-point Likert scale to assess the model's realism (face validity) and its effectiveness as training tool (content validity).

RESULTS

Regarding the training status, 20/53 (37.7%) participants were fellow and/or specialist in pediatric surgery and 33/53 (62.3%) were surgeons in training. Their level of confidence in endoscopic injection procedure was defined as novice (< 10 procedures per year) in 33/53 (62.3%), intermediate (10-20 procedures per year) in 10/53 (18.9%), and expert (> 20 procedures per year) in 10/53 (18.9%). Regarding both face validity and content validity assessments, no statistically significant differences were found between scores given by novice vs intermediate/expert groups. Similarly, no statistically significant differences emerged between scores given by participant vs faculty groups assessing the content validity of the FTSM. The FTSM was considered a good teaching tool for beginners by 44/53 (83%) and for pediatric surgeons/urologists by 38/53 (71.7%).

CONCLUSIONS

The 3D-printed Fish Tank Simulation Model proved to be a valuable, high-fidelity, easily accessible, cost-effective, hygienic, and domestic-use training tool for pediatric surgeons/urologists conducting the procedure. The model's user-friendly design and realistic environment enhanced learning opportunities for trainees, regardless of their experience level or training status. Nevertheless, further development is necessary, particularly in enhancing the realism of the ureteral hiatus and reproducing more complex anatomy, to make it beneficial for the training of advanced surgeons.

Skill progress during a dedicated societal robotic surgery training curriculum including several robotic surgery platforms

BACKGROUND

Robot-assisted procedures are increasingly common, and several systems are available for thoraco-abdominal surgery. Specific structured training is necessary, while access to these systems is still limited. This study aimed to assess surgeons' skill progress during consecutive training days of a curriculum with exposure to different robotic systems.

METHODS

This prospective observational study enrolled 47 surgeons with anonymized analysis of SimNow™ simulator performance scores and dedicated questionnaires after written consent. The primary outcome was the overall score, based on economy of motion, time to complete the exercise, and penalty for errors. Course participants in 2022-2023 had chosen 2 full hands-on days on Da Vinci® consoles with either virtual reality (VR) simulation training using the SimNow (n = 21, 44.7%) or digestive surgery procedures with a live animal model (n = 26, 55.3%). In all participants, training on Da Vinci® systems included console functions and principles of docking, camera, and instrument use for console and procedural training. They additionally had access to introductory dry-lab and VR simulator exercises on the Versius, HugoTMRAS, and Dexter systems and to VR exercises on the ROBOTiS simulator.

RESULTS

The participants (16F/31M, median age 40 years, range 29-58) from various surgical specialties (general/visceral/vascular) had no (n = 35, 74.5%) or little (n = 12, 25.5%) robotic experience including bedside assistance only and 20 (42.6%) had robotic simulator experience. The demographic variables fully completed by 44/47 participants (93.6%) and choice of module had no significant impact on the primary outcome. The considerable performance improvement from days 1 to 2 was exemplified by a significantly increased economy of motion and decreased amount of excessive force.

CONCLUSION

Robotic surgical training is increasingly complex with several systems on the market. Within a dedicated robotic surgery curriculum and based on integrated performance metrics, a significant improvement of skill levels was observed in a relatively short period of time.

Early introduction of simulation in the medical curriculum: the MedInTo perspective

Despite the increasing body of evidence supporting the use of simulation in medicine, a question remains: when should we introduce it into the medical school's curriculum? We present the experience and future perspectives of the MD program in Medicine and Surgery of University of Turin-MedInTo. Since its launch, MedInTo has been dedicated to integrating innovative teaching approaches at the early stages into the medical curriculum. Herewith, we describe a case-based approach for our activities, which includes the utilization of simulation for emergency medical care training for students and the integration of virtual and augmented reality technology. Dedicated surgical training activities using virtual-augmented reality and life-like simulator for students are also described.