Novel Education and Simulation Tools in Urologic Training

Childs, Brandon S; Manganiello, Marc; Korets, Ruslan

doi:10.1007/s11934-019-0947-8

Cited by 37 publications

(18 citation statements)

References 47 publications

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“…On the other hand, simulators are considered another attractive models for training during the learning curve of enucleation or transurethral resection of the prostate [31][32][33]. However, it should be noted the actual operative experience is an essential part of the training process, thus, simulation should be used only in conjunction with traditional teaching methods [33].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study

et al. 2021

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Introduction Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients’ safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03594-9.

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Section: Discussionmentioning

confidence: 99%

Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study

et al. 2021

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“…Urology simulation curricula and bootcamps have been shown to increase trainee competence and decrease time to develop laparoscopic skills. As such, the evidence to support incorporating laparoscopic skills training into urology programs has long been acquired [16][17][18][19] with the majority of Canadian urology programs offering laparoscopic simulation training. 10 In realworld clinical practice however, laparoscopic surgery takes place in an operating room with multidisciplinary teams.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhaging laparoscopic partial nephrectomy — feasibility of a novel simulation model

Lusty

Bleackley²,

Roberts³

et al. 2021

CUAJ

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Introduction: Intraoperative surgical complications pose significant potential risks to patients. Uncontrolled bleeding during laparoscopic partial nephrectomy is one such event that requires collaboration and communication between surgical team members. We developed and evaluated a multidisciplinary surgical simulation scenario and model of intraoperative hemorrhage during a laparoscopic partial nephrectomy to facilitate the practice of these crucial non-technical skills. Methods: A simulation scenario using a novel, titratable bleeding partial nephrectomy model was developed. The operating room simulation consisted of an intubated mannequin placed in the lateral decubitus position and laparoscopic renal model. The multidisciplinary simulation scenario included anesthesia and urology residents and progressed from bleeding to a pulseless electrical activity arrest. The degree of renal model bleeding was modified based on the progression of the urology resident. After the scenario participants were debriefed and completed a post-simulation survey assessing: 1) their perception of the simulated scenario; and 2) their teaching of non-technical skills in their residency training. Results: The porcine model was successfully reproduced for nine consecutive weeks and functioned well to simulate bleeding from a laparoscopic partial nephrectomy site; the bleeding was able to be titrated based on resident progression and excision of the simulated tumor. All residents stated the scenario was valuable to assess and improve non-technical surgical skills and that their exposure to practice non-technical skills in their existing curriculum could be improved. Conclusions: Simulating an intraoperative bleeding partial nephrectomy, combined with an intraoperative crisis scenario, is a feasible, immersive, and reproducible model and can challenge residents’ non-technical skills.

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“…To combine human anatomy and live physiological conditions, human cadavers have been artificially perfused to replicate real‐life parameters of dissection and haemostasis [19], but are limited by positive viral profiles, difficulty clearing the vascular tree, and high costs ($1000/cadaver) [20,21]. A recent review of novel education and simulation tools in urological training concluded that, while wet facilities offer trainees the opportunity to practise their skills, access remains a difficulty due to costs and availability [22]. It also highlighted the need for more objective metrics to demonstrate skill improvement that can be linked to patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Multi‐institutional validation of a perfused robot‐assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS)

et al. 2020

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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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Novel Education and Simulation Tools in Urologic Training

Cited by 37 publications

References 47 publications

Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study

Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study

Hemorrhaging laparoscopic partial nephrectomy — feasibility of a novel simulation model

Multi‐institutional validation of a perfused robot‐assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS)

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