Percutaneous renal access training: content validation comparison between a live porcine and a virtual reality (VR) simulation model

Abstract

• To compare the content validity (realism and usefulness) of percutaneous renal access (PRA) obtained on a live porcine model and a high-fidelity computer-based surgical simulator (PERC Mentor, Simbionix; Lod, Israel) in our skills laboratory for trainees interested in PRA training, so as to determine which of the two is a more appropriate and effective training model. • In all, 24 'experts' performed PRA in a live porcine model and using the PERC Mentor. • The porcine model access required a live anaesthetized pig with a pre-placed ureteric catheter. The access was done with flouroscopic guidance using a 22-G 'skinny' needle (Cook Medical, Bloomington, IN, USA). • Then the specific task of PRA using a similar case scenario was done using the PERC Mentor. • The experts rated the models using a questionnaire based on a 5-point Likert scale, consisting of 10- and three-items of realism and usefulness, respectively. • Of the 10 items of realism assessed, the porcine model was rated as better than the PERC Mentor for 'overall realism', 'movement of the kidney', 'tactile feedback of perinephric space', 'fluoroscopic realism' and 'complications encountered' (All P < 0.001). • It was inferior to the PERC Mentor for 'orientation to the flank', 'aspiration', 'repetitive performance' and 'organisational feasibility' (All P < 0.001). • 'Tactile feedback of successful access' was similar in both models (mean [sd] points, 4.24 [0.7] vs 4.6 [0.5]). • Of the three items of usefulness, 'overall usefulness' (4.6 [0.6] vs 4.65 [0.5]) and 'use as a training tool' (4.32 [0.5] vs 4.75 [0.4]) was similar; however, the porcine model was a much better assessment tool (P < 0.001). • Both models have relative advantages and disadvantages. The live porcine model is a more realistic assessment tool for PRA. The specific advantage of the PERC Mentor is of repetitive tasking and easier set up feasibility. • The overall usefulness was same for both the models.