Development and Validation of a Simulation Model for Ureteral Stent Placement.

Abstract

Currently, there are no validated training models for cystoscopy with ureteral stent placement. The objectives of this study were to develop and validate a novel endoscopic simulation model for training in ureteral stent placement. A low-cost, low-fidelity training model was developed to simulate ureteral stent placement. Recruited participants were divided into 3 groups: novices (postgraduate year 3/4 gynecology residents), advanced learners (urogynecology and reconstructive pelvic surgery fellows), and experts (urology residents, urogynecology faculty, and urology faculty). Construct validity was measured using de-identified video-recorded performances on the model, which were evaluated by 2 expert reviewers using validated scales (Global Operative Assessment of Laparoscopic Skills [GOALS], Global Rating Scale [GRS]) and procedure-specific metrics. The model was created using a hollow Styrofoam sphere, plastic tubing from a retropubic sling, and a silicone pacifier. Thirty-six surgeons were assessed performing the procedure using the model with cystoscopic equipment. The experts (n = 12) performed significantly better than the advanced learners (n = 17) and novices (n = 7) in total scores (max 75, median [IQR]: 75 [75-75], 61 [56.5-68.5], 45 [43-46], respectively; P < 0.001) and within each individual scale domain. Increasing experience with ureteral stent placement had a significant correlation (P < 0.001) with better performance on the model. A minimum total passing score of 63 was established. On post simulation assessment, most participants "agreed" or "strongly agreed" that the model closely approximates the feel of ureteral stent placement. This ureteral stenting simulation model is easy to construct, affordable, and reproducible. The model is valid and reliable for practicing the procedure in preparation for live surgery.