Abstract
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.
Summary
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.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Abboudi H, Khan MS, Aboumarzouk O, Guru KA, Challacombe B, Dasgupta P, et al. Current status of validation for robotic surgery simulators–a systematic review. BJU Int. 2013;111(2):194–205. https://doi.org/10.1111/j.1464-410X.2012.11270.x. Systematic review of validation within the field of robotic simulators.
•• MacCraith E, Forde JC, Davis NF. Robotic simulation training for urological trainees: a comprehensive review on cost, merits and challenges. J Robot Surg. 2019;13(3):371–7. https://doi.org/10.1007/s11701-019-00934-1 Complete review of all current available robotic simulators, their cost, and advantages/disadvantages.
Hertz AM, George EI, Vaccaro CM, Brand TC. Head-to-head comparison of three virtual-reality robotic surgery simulators. JSLS. 2018;22(1):e2017.00081. https://doi.org/10.4293/JSLS.2017.00081.
• Hoogenes J, Wong N, Al-Harbi B, Kim KS, Vij S, Bolognone E, et al. A randomized comparison of 2 robotic virtual reality simulators and evaluation of trainees’ skills transfer to a simulated robotic urethrovesical anastomosis task. Urology. 2018;111:110–5. https://doi.org/10.1016/j.urology.2017.09.023. dVSSS trainer led to higher GEARS and RACE scores vs. dV-T for performance of the urethrovesical anastomosis task in junior trainees but not seniors.
McDonough P, Peterson A, Brand T. Initial validation of the ProMIS surgical simulator as an objective measure of robotic task performance. J Urol. 2010;183(4):e515.
Jonsson MN, Mahmood M, Askerud T, Hellborg H, Ramel S, Wiklund NP, et al. ProMIS™ can serve as a da Vinci® simulator—a construct validity study. J Endourol. 2011;25(2):345–50. https://doi.org/10.1089/end.2010.0220.
Gavazzi A, Bahsoun AN, Van Haute W, Ahmed K, Elhage O, Jaye P, et al. Face, content and construct validity of a virtual reality simulator for robotic surgery (SEP Robot). Ann R Coll Surg Engl. 2011;93(2):152–6. https://doi.org/10.1308/003588411X12851639108358.
Seixas-Mikelus SA, Kesavadas T, Srimathveeravalli G, Chandrasekhar R, Wilding GE, Guru KA. Face validation of a novel robotic surgical simulator. Urology. 2010;76(2):357–60. https://doi.org/10.1016/j.urology.2009.11.069.
Kamel M, Eltahawy EA, Warford R, Thrush CR, Noureldin YA. Simulation-based training in urology residency programmes in the USA: results of a nationwide survey. Arab J Urol. 2018;16(4):446–52. https://doi.org/10.1016/j.aju.2018.06.003.
Van der Meijden OA, Schijven MP. The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review. Surg Endosc. 2009;23(6):1180–90. https://doi.org/10.1007/s00464-008-0298-x.
• Moglia A, Ferrari V, Morelli L, Ferrari M, Mosca F, Cuschieri A. A systematic review of virtual reality simulators for robot-assisted surgery. Eur Urol. 2016;69(6):1065–80. https://doi.org/10.1016/j.eururo.2015.09.021. Systematic review concluding that there is an urgent need for a large, multicenter, randomized controlled trial to assess the transferability of skills into the operating room.
• Nagendran M, Toon CD, Davidson BR, Gurusamy KS. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. Cochrane Database Syst Rev. 2014;(1):CD010479. https://doi.org/10.1002/14651858.CD010479.pub2.
Aslam A, Nason GJ, Giri SK. Homemade laparoscopic surgical simulator: a cost-effective solution to the challenge of acquiring laparoscopic skills? Ir J Med Sci. 2016;185(4):791–6. Cochrane review concluded that laparoscopic box trainers (box, animal, and cadaveric models) appear to improve the overall skill of trainees with no prior experience.
Makiyama K, Yamanaka H, Ueno D, Ohsaka K, Sano F, Nakaigawa N, et al. Validation of a patient-specific simulator for laparoscopic renal surgery. Int J Urol. 2015;22(6):572–6. https://doi.org/10.1111/iju.12737.
Inoue T, Okada S, Hamamoto S, Matsuda T. New advanced bench model for flexible ureteroscopic training: the smart simulator. J Endourol. 2018;32(1):22–7.
de la Rosette JJ, Laguna MP, Rassweiler JJ, Conort P. Training in percutaneous nephrolithotomy—a critical review. Eur Urol. 2008;54(5):994–1001. https://doi.org/10.1016/j.eururo.2008.03.052.
• Ghazi A, Campbell T, Melnyk R, Feng C, Andrusco A, Stone J, et al. Validation of a full-immersion simulation platform for percutaneous nephrolithotomy using three-dimensional printing technology. J Endourol. 2017;31(12):1314–20. https://doi.org/10.1089/end.2017.0366. Validated, 3-D print model for PCNL for full immersion simulation.
Parkhomenko E, O'Leary M, Safiullah S, Walia S, Owyong M, Lin C, et al. Pilot assessment of immersive virtual reality renal models as an educational and preoperative planning tool for percutaneous nephrolithotomy. J Endourol. 2019;33(4):283–8. https://doi.org/10.1089/end.2018.0626.
•• Khan R, Aydin A, Khan MS, Dasgupta P, Ahmed K. Simulation-based training for prostate surgery. BJU Int. 2015;116(4):665–74. https://doi.org/10.1111/bju.12721 Thorough review of all simulators available for prostate surgery.
Hudak SJ, Landt CL, Hernandez J, Soderdahl DW. External validation of a virtual reality transurethral resection of the prostate simulator. J Urol. 2010;184(5):2018–22. https://doi.org/10.1016/j.juro.2010.06.141.
Aydin A, Muir GH, Khan MS, Dasgupta P, Ahmed K. Validation of the GreenLight Simulator and development of a training curriculum for GreenLight Laser Prostatectomy. Eur Urol Suppl. 2014;13(1):e874-b.
Kuronen-Stewart C, Ahmed K, Aydin A, Cynk M, Miller P, Dasgupta P, et al. MP14-17 Assessment of face, construct and content validity of a novel virtual reality simulator for holmium laser enucleation of the prostate. Urology. 2015;86(3):639–46. https://doi.org/10.1016/j.urology.2015.06.008.
de Vries AH, van Genugten HG, Hendrikx AJ, Koldewijn EL, Schout BM, Tjiam IM, et al. The Simbla TURBT simulator in urological residency training: from needs analysis to validation. J Endourol. 2016;30(5):580–7. https://doi.org/10.1089/end.2015.0723.
Fiard G, Selmi SY, Promayon E, Vadcard L, Descotes JL, Troccaz J. Initial validation of a virtual-reality learning environment for prostate biopsies: realism matters! J Endourol. 2014;28(4):453–8. https://doi.org/10.1089/end.2013.0454.
• Rowley K, Pruthi D, Al-Bayati O, Basler J, Liss MA. Novel use of household items in open and robotic surgical skills resident education. Adv Urol. 2019;2019:5794957. https://doi.org/10.1155/2019/5794957. Low-fidelity, inexpensive, surgical simulators which are easily reproducible at home have been shown to improve open surgical skills.
Singal A, Halverson A, Rooney DM, Davis LM, Kielb SJ. A validated low-cost training model for suprapubic catheter insertion. Urology. 2015;85(1):23–6. https://doi.org/10.1016/j.urology.2014.08.024.
Lentz AC, Rodríguez D, Davis LG, Apoj M, Kerfoot BP, Perito P, et al. Simulation training in penile implant surgery: assessment of surgical confidence and knowledge with cadaveric laboratory training. Sex Med. 2018;6(4):332–8. https://doi.org/10.1016/j.esxm.2018.09.001.
Bertolo R, Garisto J, Dagenais J, Sagalovich D, Kaouk JH. Single session of robotic human cadaver training: the immediate impact on urology residents in a teaching hospital. J Laparoendosc Adv Surg Tech A. 2018;28(10):1157–62. https://doi.org/10.1089/lap.2018.0109.
Lin C, Gao J, Zheng H, Zhao J, Yang H, Zheng Y, et al. When to introduce three-dimensional visualization technology into surgical residency: a randomized controlled trial. J Med Syst. 2019;43(3):71. https://doi.org/10.1007/s10916-019-1157-0.
Porpiglia F, Bertolo R, Checcucci E, Amparore D, Autorino R, Dasgupta P, et al. Development and validation of 3D printed virtual models for robot-assisted radical prostatectomy and partial nephrectomy: urologists’ and patients’ perception. World J Urol. 2018;36(2):201–7. https://doi.org/10.1007/s00345-017-2126-1.
Shee K, Koo K, Wu X, Ghali FM, Halter RJ, Hyams ES. A novel ex vivo trainer for robotic vesicourethral anastomosis. J Robot Surg. 2019:1–7. https://doi.org/10.1007/s11701-019-00926-1.
• Rodgers A, Trinchieri A, Ather MH, Buchholz N. Vision for the future on urolithiasis: research, management, education and training—some personal views. Urolithiasis. 2018:1–3. https://doi.org/10.1007/s00240-018-1086-2. Discusses the benefits of augmented reality in the urological field, in particular to its benefits related to percutaneous nephrolithotomy.
• Bertolo R, Hung A, Porpiglia F, Bove P, Schleicher M, Dasgupta P. Systematic review of augmented reality in urological interventions: the evidences of an impact on surgical outcomes are yet to come. World J Urol. 2019. https://doi.org/10.1007/s00345-019-02711-z. Limited benefits of augmented reality currently in comparison with conventional surgery.
• Brook NR, Dell’Oglio P, Barod R, Collins J, Mottrie A. Comprehensive training in robotic surgery. Curr Opin Urol. 2019;29(1):1–9. https://doi.org/10.1097/MOU.0000000000000566. Discusses the establishment of robotic cirricula for training of novice surgeons.
Volpe A, Ahmed K, Dasgupta P, Ficarra V, Novara G, van der Poel H, et al. Pilot validation study of the European Association of Urology robotic training curriculum. Eur Urol. 2015;68(2):292–9. https://doi.org/10.1016/j.eururo.2014.10.025.
Hanchanale V, Kailavasan M, Rajpal S, Koenig P, Yiasemidou M, Palit V, et al. Impact of urology simulation boot camp in improving endoscopic instrument knowledge. BMJ Simulation and Technology Enhanced Learning. 2018:bmjstel-2018.
Kailavasan M, Hanchanale V, Rajpal S, Morley R, Mcllhenny C, Somani B, et al. A method to evaluate trainee progression during simulation training at the Urology Simulation Boot Camp (USBC) course. J Surg Educ. 2019;76(1):215–22. https://doi.org/10.1016/j.jsurg.2018.06.020.
Ahmed K, Aydin A, Dasgupta P, Khan MS, McCabe JE. A novel cadaveric simulation program in urology. J Surg Educ. 2015;72(4):556–65. https://doi.org/10.1016/j.jsurg.2015.01.005.
Somasundram K, Spence H, Colquhoun AJ, Mcilhenny C, Biyani CS, Jain S. Simulation in urology to train non-technical skills in ward rounds. BJU Int. 2018;122(4):705–12. https://doi.org/10.1111/bju.14402.
Goh AC, Goldfarb DW, Sander JC, Miles BJ, Dunkin BJ. Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills. J Urol. 2012;187(1):247–52. https://doi.org/10.1016/j.juro.2011.09.032.
Van Hove PD, Tuijthof GJ, Verdaasdonk EG, Stassen LP, Dankelman J. Objective assessment of technical surgical skills. Br J Surg. 2010;97(7):972–87.
Martin JA, Regehr G, Reznick R, Macrae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg. 1997;84(2):273–8.
Handelman A, Schnaider S, Schwartz-Ossad A, Barkan R, Tepper R. Computerized model for objectively evaluating cutting performance using a laparoscopic box trainer simulator. Surg Endosc. 2019;33(9):2941–50. https://doi.org/10.1007/s00464-018-6598-x.
• Hung AJ, Chen J, Jarc A, Hatcher D, Djaladat H, Gill IS. Development and validation of objective performance metrics for robot-assisted radical prostatectomy: a pilot study. J Urol. 2018;199(1):296–304. https://doi.org/10.1016/j.juro.2017.07.081. The establishment of automated performance metrics within the field of urology and specifically radical robotic-assisted prostatectomy.
Chen J, Oh PJ, Cheng N, Shah A, Montez J, Jarc A, et al. Use of automated performance metrics to measure surgeon performance during robotic vesicourethral anastomosis and methodical development of a training tutorial. J Urol. 2018;200(4):895–902. https://doi.org/10.1016/j.juro.2018.05.080.
Kim SS, Blankstein U, Ordon M, Pace KT, Honey RJ, Lee JY, et al. Evaluation of optimal timing of expert feedback in a simulated flexible ureteroscopy course. J Endourol. 2019;33(6):463–7. https://doi.org/10.1089/end.2018.0732.
•• Sweet R. Taskforce Update: PGY-1 Curriculum Education Tools. [online] Sauweb.org. 2019. https://sauweb.org/docs/taskforces/pgy-1-curriculum-education-tools.aspx. Accessed 12 Jun 2019. A taskforce was created by the Society of Academic Urologists in order to aid in the establishment of a standardized curriculum for urology residents.
Manganiello M, Haleblian G, Canes D, Chang P, Wagner A, Korets R. Multi-institutional pilot evaluation of an online feedback platform for surgical skill acquisition. New England Section of American Urological Association Annual Meeting. Montreal CA 2017.
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Brandon S. Childs, Marc D. Manganiello, and Ruslan Korets each declare no potential conflicts of interest.
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Childs, B.S., Manganiello, M.D. & Korets, R. Novel Education and Simulation Tools in Urologic Training. Curr Urol Rep 20, 81 (2019). https://doi.org/10.1007/s11934-019-0947-8
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DOI: https://doi.org/10.1007/s11934-019-0947-8