ObjectivesTo incorporate and validate clinically relevant performance metrics of simulation (CRPMS) into a hydrogel model for nerve-sparing robot-assisted radical prostatectomy (NS-RARP).
Materials and MethodsAnatomically accurate models of the human pelvis, bladder, prostate, urethra, neurovascular bundle (NVB) and relevant adjacent structures were created from patient MRI by injecting polyvinyl alcohol (PVA) hydrogels into threedimensionally printed injection molds. The following steps of NS-RARP were simulated: bladder neck dissection; seminal vesicle mobilization; NVB dissection; and urethrovesical anastomosis (UVA). Five experts (caseload >500) and nine novices (caseload <50) completed the simulation. Force applied to the NVB during the dissection was quantified by a novel tension wire sensor system fabricated into the NVB. Post-simulation margin status (assessed by induction of chemiluminescent reaction with fluorescent dye mixed into the prostate PVA) and UVA weathertightness (via a standard 180-mL leak test) were also assessed. Objective scoring, using Global Evaluative Assessment of Robotic Skills (GEARS) and Robotic Anastomosis Competency Evaluation (RACE), was performed by two blinded surgeons. GEARS scores were correlated with forces applied to the NVB, and RACE scores were correlated with UVA leak rates. Incorporating clinical metrics in a RARP model sparing radical prostatectomy and fruit for simple prostatectomy. Korean J Urol 2011; 52: 130-5 34 Clarebrough E, Christidis D, Lindner U, Fernandes K, Fleshner N, Lawrentschuk N. Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy. World J Urol 2019; 37: 799-804
We demonstrated the face, content, and construct validity of an inanimate, full task trainer for PCNL. Construct validity between experts and novices was demonstrated using incorporated procedural metrics, which permitted the accurate assessment of performance. While hands-on training under supervision remains an integral part of any residency, this full-immersion simulation provides a comprehensive tool for surgical skills development and evaluation before hands-on exposure.
BACKGROUND
The development of technical skills for a cervical laminectomy are traditionally acquired through intraoperative learning and cadaveric courses. These methods provide little objective assessment, involve financial and biohazard considerations, and may not incorporate desired pathology.
OBJECTIVE
To develop an inexpensive cervical spine laminectomy simulator capable of measuring operative performance and to assess its face, content, and construct validity.
METHODS
A virtual model was generated and 3D printed into negative molds. A multilayered surgical phantom was fabricating by filling molds with hydrogels, plaster, and fiberglass. A pressure transducer measured simulated spinal cord manipulation. Participants completed full-procedural laminectomy simulations. Post-simulation surveys assessed face and content validity. Construct validity was assessed by comparing expert and novice procedural metrics.
RESULTS
Twelve surgeons participated. The simulator received median face and content validity ratings of 4/5. Differences between experts and novices were found in mean intrathecal pressure wave count (84 vs 153, P = .023), amplitude (4 vs 12% > 2SD above expert mean, P < .001), area under curve (4 vs 12% > 2SD above expert mean, P < .001), procedure time (35 vs 69 min P = .003), and complication rates (none vs 3 incorrect levels decompressed and 1 dural tear, P = .06). Insignificant differences were found in mean pressure wave slope and blood loss.
CONCLUSION
This inexpensive cervical laminectomy simulator received favorable face and content validity ratings, and distinguished novice from expert participants. Further studies are needed to determine this simulator's role in the training and assessment of novice surgeons.
Objective
To conduct a multi‐institutional validation of a high‐fidelity, perfused, inanimate, simulation platform for robot‐assisted partial nephrectomy (RAPN) using incorporated clinically relevant objective metrics of simulation (CROMS), applying modern validity standards.
Materials and Methods
Using a combination of three‐dimensional (3D) printing and hydrogel casting, a RAPN model was developed from the computed tomography scan of a patient with a 4.2‐cm, upper‐pole renal tumour (RENAL nephrometry score 7×). 3D‐printed casts designed from the patient’s imaging were used to fabricate and register hydrogel (polyvinyl alcohol) components of the kidney, including the vascular and pelvicalyceal systems. After mechanical and anatomical verification of the kidney phantom, it was surrounded by other relevant hydrogel organs and placed in a laparoscopic trainer. Twenty‐seven novice and 16 expert urologists, categorized according to caseload, from five academic institutions completed the simulation.
Results
Clinically relevant objective metrics of simulators, operative complications, and objective performance ratings (Global Evaluative Assessment of Robotic Skills [GEARS]) were compared between groups using Wilcoxon rank‐sum (continuous variables) and parametric chi‐squared (categorical variables) tests. Pearson and point‐biserial correlation coefficients were used to correlate GEARS scores to each CROMS variable. Post‐simulation questionnaires were used to obtain subjective supplementation of realism ratings and training effectiveness.
Results
Expert ratings demonstrated the model’s superiority to other procedural simulations in replicating procedural steps, bleeding, tissue texture and appearance. A significant difference between groups was demonstrated in CROMS [console time (P < 0.001), warm ischaemia time (P < 0.001), estimated blood loss (P < 0.001)] and GEARS (P < 0.001). Six major intra‐operative complications occurred only in novice simulations. GEARS scores highly correlated with the CROMS.
Conclusions
This perfused, procedural model offers an unprecedented realistic simulation platform, which incorporates objective, clinically relevant and procedure‐specific performance metrics.
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