Simulation in urology – a role for virtual reality?

Shah, Jyoti; Mackay, Sean; Vale, J. A.; Darzi, Ara

doi:10.1046/j.1464-410x.2001.02320.x

Cited by 40 publications

(24 citation statements)

References 16 publications

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“…In theory simulation represents an attractive approach to provide reality based training without harming patients. 11 Simulation provides intricate performance metrics that highlight areas to improve. For the first time teaching surgeons can gain quantitative insight into exactly how trainees learn procedural skills.…”

Section: Discussionmentioning

confidence: 99%

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The Virtual Reality Transurethral Prostatic Resection Trainer: Evaluation of Discriminate Validity

et al. 2007

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Different factors determine transurethral prostate resection performance metrics among experts, residents and novices. These correlations reinforce discriminate validity and provide insight into specific factors that likely determine success at different training levels. Such data could be used to isolate and train skill subsets in the curriculum and they may elucidate the safest and most efficient approach to train resection skills.

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Section: Discussionmentioning

confidence: 99%

“…12 Effective simulators must also be interactive and react with reality when manipulated, eg bleed when cut. 11,12 With that said, realism in simulation is simply a means by which to achieve the true overlying objective of whether the simulator actually trains and whether it can accurately assess skill.…”

Section: Discussionmentioning

confidence: 99%

The Virtual Reality Transurethral Prostatic Resection Trainer: Evaluation of Discriminate Validity

et al. 2007

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“…[8][9][10] Other reasons for using simulators include decreasing access to patients for training purposes, time constraints for teaching during procedures due to demands for greater efficiency and shorter working hours for residents; simulators can also be used as a tool to assess initial competence and subsequent recertification. 11 Other industries, most notably the aviation industry, have long used simulators for this purpose, where both initial training and subsequent re-certification can be performed safely without putting lives in danger.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a virtual reality transrectal ultrasound guided prostatic biopsy simulator

Chalasani

Cool²,

Sherebrin³

et al. 2013

CUAJ

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Objective: We present the design, reliability, face, content and construct validity testing of a virtual reality simulator for transrectal ultrasound (TRUS), which allows doctors-in-training to perform multiple different biopsy schemes. Methods: This biopsy system design uses a regular "end-firing" TRUS probe. Movements of the probe are tracked with a micromagnetic sensor to dynamically slice through a phantom patient's 3D prostate volume to provide real-time continuous TRUS views. 3D TRUS scans during prostate biopsy clinics were recorded. Intrinsic reliability was assessed by comparing the left side of the prostate to the right side of the prostate for each biopsy. A content and face validity questionnaire was administered to 26 doctors to assess the simulator. Construct validity was assessed by comparing notes from experts and novices with regards to the time taken and the accuracy of each biopsy. Results: Imaging data from 50 patients were integrated into the simulator. The completed VR TRUS simulator uses real patient images, and is able to provide simulation for 50 cases, with a haptic interface that uses a standard TRUS probe and biopsy needle. Intrinsic reliability was successfully demonstrated by comparing results from the left and right sides of the prostate. Face and content validity respondents noted the realism of the simulator, and its appropriateness as a teaching model. The simulator was able to distinguish between experts and novices during construct validity testing. Conclusions: A virtual reality TRUS simulator has successfully been created. It has promising face, content and construct validity results. IntroductionThe current gold standard and the most widely used method to diagnose prostate cancer is transrectal ultrasound (TRUS)-guided prostatic biopsy, which is commonly performed in Westernized high income countries. For instance, in Australia in 2008 a total of 26 146 TRUS guided biopsies of the prostate were performed. 1Transrectal ultrasound-guided prostatic biopsy does have well-documented complications. A recently published Japanese nationwide survey of more than 200 000 prostatic biopsies revealed that complications occurred frequently, with hematuria in 12%, hematochezia in 5.9%, hematospermia in 1.2%, fever in 1.1%, sepsis in 0.07%, voiding symptoms in 1.9%, urinary retention in 1.1% and prostatitis in 0.9%. Hospitalization to treat complications occurred in 0.69% of the entire cohort.2 Mortality rates at 120 days of 1.3% have been also been reported from a cohort of 22 175 patients by Gallina and colleagues.

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“…Significant improvements were noted for resection rates from 26.5 ( 8 9.6) to tentially shorten the learning process, especially for junior trainees in a safe and controlled environment, while also demonstrating a beneficial impact on resident surgical and endoscopic skills [1] . Ureteroscopy [2] and transurethral resection simulators [3,4] have been successfully evaluated in previous studies, and a growing body of publications have underlined their potential role in resident education [5] . Their availability, however, has been limited to a few centers.…”

Section: Introductionmentioning

confidence: 99%

Virtual Bladder Tumor Transurethral Resection: An Objective Evaluation Tool to Overcome Learning Curves with and without Photodynamic Diagnostics

et al. 2011

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Introduction: Virtual reality (VR) simulation has been known to shorten learning curves. The aim of this research was to determine whether VR transurethral bladder tumor resection (TURBT) with and without photodynamic diagnostic (PDD) can improve endourological skills in novice and trained endoscopists. Materials and Methods: Residents without experience (n = 15) completed five 5-min white light VR-TURBT scenarios. The trained endoscopists (≧25 TURBTs; n = 15) performed five 5-min VR resections using white light and PDD cystoscopy. The VR-TURBT performance with the Uro-Trainer® (Karl Storz GmbH, Germany) was compared between the first and last 5 cases using computer-generated parameters [inspected area (%), resected tumor mass (%) and bleeding (ml)]. The trained endoscopists’ parameters were compared with white light versus PDD-VR-TURBT. Results: Among novices, the inspected area increased from 36.8 (±12.9) to 54.3% (±7.3), p < 0.05. Significant improvements were noted for resection rates from 26.5 (±9.6) to 52.0% (±6.0), p < 0.05. Trained urologists showed superior inspection [52.2 (±3.4) vs. 62.7% (±4.3), p = 0.003] and resection rates [43.8 (±3.3) vs. 57.1% (±5.3), p = 0.002] with PDD. Conclusions: The opportunity to evaluate objective patient-independent measurements establishes the Uro-Trainer as a beneficial tool in enhancing TURBT quality. Results demonstrated that novices improved their ability to perform complete resection, and the TURBT rates of trained urologists were superior in PDD compared with a white light setting.

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Simulation in urology – a role for virtual reality?

Cited by 40 publications

References 16 publications

The Virtual Reality Transurethral Prostatic Resection Trainer: Evaluation of Discriminate Validity

The Virtual Reality Transurethral Prostatic Resection Trainer: Evaluation of Discriminate Validity

Development and validation of a virtual reality transrectal ultrasound guided prostatic biopsy simulator

Virtual Bladder Tumor Transurethral Resection: An Objective Evaluation Tool to Overcome Learning Curves with and without Photodynamic Diagnostics

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