Current Urology Reports

, Volume 7, Issue 2, pp 107–113 | Cite as

Simulation training in video-assisted urologic surgery

  • András Hoznek
  • Laurent Salomon
  • Alexandre de la Taille
  • René Yiou
  • Dimitrios Vordos
  • Stéphane Larre
  • Clément-Claude Abbou


The current system of surgical education is facing many challenges in terms of time ef.ciency, 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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    USAF Museum. Link Trainer. http://www.wpaf museum/early_years/ey19a.htm. Accessed January 4, 2006.Google Scholar
  2. 2.
    Safar P, Escarraga LA, Elam JO: A comparison of the mouth-to-mouth and mouth-to-airway methods of arti.cial respiration with the chest-pressure arm-lift methods. N Engl J Med 1958, 258:671–677.PubMedCrossRefGoogle Scholar
  3. 3.
    Grenvik A, Schaefer J: From Resusci-Anne to Sim-Man: the evolution of simulators in medicine. Crit Care Med 2004, 32(suppl):S56-S57.PubMedCrossRefGoogle Scholar
  4. 4.
    Delp SL, Loan JP, Hoy MG, et al.: An interactive graphicsbased model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng 1990, 37:757–767.PubMedCrossRefGoogle Scholar
  5. 5.
    Scott DJ, Bergen PC, Rege RV, et al.: Laparoscopic training on bench models: Better and more cost effective than operating room experience? J Am Coll Surg 2000, 191:272–283.PubMedCrossRefGoogle Scholar
  6. 6.
    Bridges M, Diamond DL: The financial impact of teaching surgical residents in the operating room. Am J Surg 1999, 177:28–32.PubMedCrossRefGoogle Scholar
  7. 7.
    Yee B, Naik VN, Joo HS, et al.: Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education. Anesthesiology 2005, 103:241–248.PubMedCrossRefGoogle Scholar
  8. 8.
    Demirtas Y, Tulmac M, Yavuzer R, et al.: Plastic surgeon’s life: marvelous for mind, exhausting for body. Plast Reconstr Surg 2004, 114:923–931.PubMedCrossRefGoogle Scholar
  9. 9.
    Haluck RS, Krummel TM: Computers and virtual reality for surgical education in the 21st century. Arch Surg 2000, 135:786–792.PubMedCrossRefGoogle Scholar
  10. 10.
    Goldman LI, McDonough MT, Rosemond GP: Stresses affecting surgical performance and learning: I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes. J Surg Res 1972, 12:83–86.PubMedCrossRefGoogle Scholar
  11. 11.
    Arraez-Aybar LA, Casado-Morales MI, Castano-Collado G: Anxiety and dissection of the human cadaver: an unsolvable relationship? Anat Rec B New Anat 2004, 279:16–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Rothbaum BO, Hodges LF, Kooper R, et al.: Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am J Psychiatry 1995, 152:626–628.PubMedGoogle Scholar
  13. 13.
    Krummel TM: Surgical simulation and virtual reality: the coming revolution. Ann Surg 1998, 228:635–637.PubMedCrossRefGoogle Scholar
  14. 14.
    Gallagher AG, Ritter EM, Satava RM: Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 2003, 17:1525–1529. This article gives the indispensable de.nitions necessary for the understanding of the methodology of validation of surgical simulators.PubMedCrossRefGoogle Scholar
  15. 15.
    Kopta JA: The development of motor skills in orthopaedic education. Clin Orthop Relat Res 1971, 75:80–85.PubMedCrossRefGoogle Scholar
  16. 16.
    Brehmer M, Tolley D: Validation of a bench model for endoscopic surgery in the upper urinary tract. Eur Urol 2002, 42:175–179.PubMedCrossRefGoogle Scholar
  17. 17.
    Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD: The effect of bench model fidelity on endourological skills: a randomized, controlled study. J Urol 2002, 167:1243–1247.PubMedCrossRefGoogle Scholar
  18. 18.
    Preminger GM, Babayan RK, Merril GL, et al.: Virtual reality surgical simulation in endoscopic urologic surgery. Stud Health Technol Inform 1996, 29:157–163.PubMedGoogle Scholar
  19. 19.
    Shah J, Montgomery B, Langley S, Darzi A: Validation of a flexible cystoscopy course. BJU Int 2002, 90:833–835.PubMedCrossRefGoogle Scholar
  20. 20.
    Jacomides L, Ogan K, Cadeddu JA, Pearle MS: Use of a virtual reality simulator for ureteroscopy training. J Urol 2004, 171:320–323.PubMedCrossRefGoogle Scholar
  21. 21.
    Watterson JD, Beiko DT, Kuan JK, Denstedt JD: Randomized, prospective, blinded study validating acquistion of ureteroscopy skills using computer-based virtual reality endourological simulator. J Urol 2002, 168:1928–1932.PubMedCrossRefGoogle Scholar
  22. 22.
    Knoll T, Trojan L, Haecker A, et al.: Validation of computer-based training in ureterorenoscopy. BJU Int 2005, 95:1276–1279.PubMedCrossRefGoogle Scholar
  23. 23.
    Ogan K, Jacomides L, Shulman MJ, et al.: Virtual ureteroscopy predicts ureteroscopic pro.ciency of medical students on a cadaver. J Urol 2004, 172:667–671.PubMedCrossRefGoogle Scholar
  24. 24.
    Ballaro A, Briggs T, Garcia-Montes F, et al.: A computergenerated interactive transurethral prostatic resection simulator. J Urol 1999, 162:1633–1635.PubMedCrossRefGoogle Scholar
  25. 25.
    Kumar PV, Gomes MP, Davies BL, Timoney AG: A computer-assisted surgical trainer for transurethral resection of the prostate. J Urol 2002, 168:2111–2114.PubMedCrossRefGoogle Scholar
  26. 26.
    Sweet R, Kowalewski T, Oppenheimer P, et al.: Face, content, and construct validity of the University of Washington virtual reality transurethral prostate resection trainer. J Urol 2004, 172:1953–1957. A well-conceived study demonstrating the face content and construct validity of a virtual TURP trainer.PubMedCrossRefGoogle Scholar
  27. 27.
    Kallstrom R, Hjertberg H, Kjolhede H, Svanvik J: Use of a virtual reality, real-time, simulation model for the training of urologists in transurethral resection of the prostate. Scand J Urol Nephrol 2005, 39:313–320.PubMedCrossRefGoogle Scholar
  28. 28.
    Hammond L, Ketchum J, Schwartz BF: A new approach to urology training: a laboratory model for percutaneous nephrolithotomy. J Urol 2004, 172:1950–1952. This article presents an original and cost-effective trainer for percutaneous renal procedures.PubMedCrossRefGoogle Scholar
  29. 29.
    Strohmaier WL, Giese A: Ex vivo training model for percutaneous renal surgery. Urol Res 2005, 33:191–193.PubMedCrossRefGoogle Scholar
  30. 30.
    Katz R, Hoznek A, Salomon L, et al.: Skill assessment of urological laparoscopic surgeons: Can criterion levels of surgical performance be determined using the pelvic box trainer? Eur Urol 2005, 47:482–487.PubMedCrossRefGoogle Scholar
  31. 31.
    Fried GM, Feldman LS, Vassiliou MC, et al.: Proving the value of simulation in laparoscopic surgery. Ann Surg 2004, 240:518–525.PubMedCrossRefGoogle Scholar
  32. 32.
    Dauster B, Steinberg AP, Vassiliou MC, et al.: Validity of the MISTELS simulator for laparoscopy training in urology. J Endourol 2005, 19:541–545.PubMedCrossRefGoogle Scholar
  33. 33.
    Chung SY, Landsittel D, Chon CH, et al.: Laparoscopic skills training using a webcam trainer. J Urol 2005, 173:180–183. The authors present an ingenious homemade and affordable laparoscopy trainer using a personal computer and a Webcam.PubMedCrossRefGoogle Scholar
  34. 34.
    Taf.nder N, Sutton C, Fishwick RJ, et al.: Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomised controlled studies using the MIST VR laparoscopic simulator. Stud Health Technol Inform 1998, 50:124–130.Google Scholar
  35. 35.
    Maithel S, Sierra R, Korndorffer J, et al.: Construct and face validity of MIST-VR, Endotower, and CELTS: Are we ready for skills assessment using simulators? Surg Endosc 2005 [Epub ahead of print].Google Scholar
  36. 36.
    Seymour NE, Gallagher AG, Roman SA, et al.: Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002, 236:458–463. This randomized, prospective study elegantly demonstrates the predictive validity of virtual reality laparoscopic trainers (ie, the possibility of transfer of the acquired skills to the operating room).PubMedCrossRefGoogle Scholar
  37. 37.
    Grantcharov TP, Kristiansen VB, Bendix J, et al.: Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 2004, 91:146–150.PubMedCrossRefGoogle Scholar
  38. 38.
    Duffy AJ, Hogle NJ, McCarthy H, et al.: Construct validity for the LAPSIM laparoscopic surgical simulator. Surg Endosc 2005, 19:401–405.PubMedCrossRefGoogle Scholar
  39. 39.
    Eriksen JR, Grantcharov T: Objective assessment of laparoscopic skills using a virtual reality stimulator. Surg Endosc 2005, 19:1216–1219.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • András Hoznek
    • 1
  • Laurent Salomon
  • Alexandre de la Taille
  • René Yiou
  • Dimitrios Vordos
  • Stéphane Larre
  • Clément-Claude Abbou
  1. 1.Service d’UrologieCentre Hospitalier Universitaire Henri Mondor, Universit’e Paris XIICr’eteil-cedexFrance

Personalised recommendations