Ureteroscopy Training Research Articles

An in vitro Comparative Assessment of Single-Use Flexible Ureteroscopes Using a Standardized Ureteroscopy Training Model

Introduction: Perceived benefits like decreased contamination rates and reduced postoperative incidence of complications after urolithiasis surgery have led to increased adoption of single-use flexible ureteroscopes (su-fURS). Using a validated, standardized simulator model with enhanced “fluoroscopic” capabilities, we performed an in vitro comparative assessment of four commercially available models of su-fURS. Both objective and subjective parameters were assessed in this study. Methods: Two standardized tasks, (1) exploration of the model’s kidney collecting system and (2) repositioning of a stone fragment from the upper renal to lower renal pole were assigned to participants, who performed these tasks on all four scopes. Four models of su-fURS (Boston LithoVue, PUSEN PU3033A, REDPINE, INNOVEX EU-ScopeTM) were assessed, with task timings as end-points for objective analysis. Cumulative “fluoroscopic” time was also recorded as a novel feature of our enhanced model. Post-task questionnaires evaluating specific components of the scopes were distributed to document subjective ratings. Results: Both subjective and objective performances (except stone repositioning time) across all four su-fURS demonstrated significant differences. However, objective performance (task timings) did not reflect subjective scope ratings by the participants (Rs < 0.6). Upon Kruskal-Wallis H test with post hoc analyses, REDPINE and INNOVEX EU-ScopeTM were the preferred su-fURS as rated by the participants, with overall scope scores of 9.00/10 and 9.57/10. Conclusions: Using a standardized in vitro simulation model with enhanced fluoroscopic capabilities, we demonstrated both objective and subjective differences between models of su-fURS. However, variations in perception of scope features (visibility, image quality, deflection, maneuverability, ease of stone retrieval) did not translate into actual technical performance. Eventually, the optimal choice of su-fURS fundamentally lies in individual surgeon preference, as well as cost-related factors.

3D printed model for flexible ureteroscopy training, a low-cost option for surgical training

IntroductionTraining in experimental models is a valid option that improves the outcomes and shortens surgical learning curves.Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. MethodsA 3D printed model was developed based on a CT scan from a real-life patient’s upper urinary tract. Horos™ software was used for segmentation and an FDM-Ultimaker for 3D printing.Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4.The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). ResultsPrinting time was 19 h, with a total cost of €8.77.The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty.The model also allowed the use of baskets and the mobilization and removal of previously placed stones. ConclusionWe unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.

Modelo impreso en 3D para entrenamiento en ureteroscopia flexible, una opción de bajo coste para el entrenamiento quirúrgico

IntroductionTraining in experimental models is a valid option that improves the outcomes and shortens surgical learning curves.Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. MethodsA 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. HorosTM software was used for segmentation and an FDM-Ultimaker for 3D printing.Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4.The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). ResultsPrinting time was 19hours, with a total cost of €8.77.The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty.The model also allowed the use of baskets and the mobilization and removal of previously placed stones. ConclusionWe unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.

A Novel Ureteroscopy Training Platform That Utilizes CT Urograms to Replicate Complex Renal Collecting System Anatomies.

Introduction: Flexible ureteroscopy (fURS) is a one-person surgical technique, limiting trainees' ability to practice intraoperatively. Although well suited for simulation training, few existing fURS simulators can accurately reproduce complex renal collecting system anatomies. We developed an anatomically accurate fURS simulator using three-dimensional (3D) reconstruction of CT urograms and 3D printing technology to address this need. Materials and Methods: Patient-specific CT urograms were used to create 3D reconstruction of the renal collecting system using Slicer™. 3D models were modified using Blender™. Hollow, elastomer kidney models were created using an Objet 3D™ printer. To test and evaluate the new fURS simulator, 25 volunteers were recruited (5 novices, 13 residents, and 7 urologists). Participants were asked to explore the model with fURS and were evaluated on their ability to deduce its 3D anatomy, their ability to navigate to prespecified calices, and their time to task completion. Furthermore, participants were asked to compare the anatomical model with existing fURS benchtop models (Cook Medical™ and Limbs & Things™) on several criteria, including internal visualization, tactile feedback, and overall functional and teaching fidelity, in a survey. Results: We were able to create a fURS simulator that accurately replicates anatomically complex renal collecting systems. In exploring the model, we noted that unlike staff urologists, novices and residents often completely missed lower pole calices. A survey comparison between our simulator and comparable benchtop simulators revealed consistently better ratings of our simulator on all criteria (p < 0.05). Conclusions: We were able to create an anatomically accurate fURS simulator that provides a more realistic scoping experience. Preliminary testing revealed that trainees will benefit from this simulator, particularly with respect to learning how to navigate challenging collecting systems.

The SIMULATE ureteroscopy training curriculum: educational value and transfer of skills

ObjectiveDifferent simulation modalities may be utilised in a curricular fashion to benefit from the strengths of each training model. The aim of this study is to evaluate a novel multi-modality ureterorenoscopy (URS) simulation curriculum in terms of educational value, content validity, transfer of skills and inter-rater reliability.MethodsThis international prospective study recruited urology residents (n = 46) with ≤ 10 URS experience and no prior simulation training. Participants were guided through each phase of the expert-developed SIMULATE URS curriculum by trainers and followed-up in the operating room (OR). Video recordings were obtained during training. A post-training evaluation survey was distributed to evaluate content validity and educational value, using descriptive statistics. Performance was evaluated using the objective structured assessment of technical skills (OSATS) scale to measure improvement in scores throughout the curriculum. Pearson’s correlation coefficient and Cohen’s kappa tests were utilised to investigate correlation and agreement between raters.ResultsParticipants reported gaining OR-transferrable skills (Mean: 4.33 ± 0.67) and demonstrated marked improvement in throughout the curriculum, transferred to the OR for both semi-rigid URS (p = 0.004) and flexible URS (p = 0.007). 70% of participants were successfully followed-up in the OR (n = 32). No differences were identified with the additional use of fresh frozen cadavers (p = 0.85, p = 0.90) and the URO Mentor VR simulator (p = 0.13, p = 0.22). A moderate level of correlation was noted on the video OSATS assessments, between two expert assessors (r = 0.70), but a poor agreement with the live rating.ConclusionThe SIMULATE URS training curriculum received high educational value from participants, who demonstrated statistically significant improvement with consecutive cases throughout the curriculum and transferability of skills to the OR in both semi-rigid and flexible URS.

Evaluation of the Endo-Uro trainer for semi-rigid ureteroscopy training.

Background:The aim of this study was to evaluate the validity of evidence of the Endo-Uro Trainer (SAMED, Dresden, Germany) for semi-rigid ureteroscopy.Methods:Novice (n = 29), intermediate-level (n = 25), and expert (n = 24) urological surgeons were recruited to participate in the study. Novices were allocated randomly to Groups A and B, where A performed two set procedures using the already validated Uro-Scopic Trainer (Limbs and Things, Bristol, UK), and Group B used the Endo-Uro trainer. Subsequently they were crossed over to perform the same two procedures using the other model. Intermediate and expert groups performed the same procedure on the Endo-Uro trainer only. Objective Structured Assessment of Technical Skills (OSATS) and the procedural times were collected and analyzed. All participants were invited to complete a final evaluation survey.Results:The evaluation survey revealed a realism rating in all aspects, with a mean Likert rating of 4.04/5. Significant differences were observed in performance time between novices and experts (p = 0.0014), and between intermediates and experts (p = 0.0113). OSATS scores differed significantly between all groups (p < 0.0001). Group B novices showed statistically significant improvement in performance time (p = 0.0012) and OSATS scores (p = 0.0439) after the crossover. Significant differences in performance time (p = 0.0025) between groups A and B were also observed post-crossover.Conclusions:This study demonstrated content validity for the Endo-Uro Trainer model. In addition, the model was shown to be capable of differentiating levels of experience, which contributes to the acceptance of the validity hypothesis. Improvement in performance using the model demonstrates its effectiveness for training.

Ureterorenoscopy training on cadavers embalmed by Thiel's method: simulation or a further step towards reality? Initial report.

IntroductionThe technique of ureterorenoscopy has a significant learning curve. Cadavers embalmed by the Thiel method have been successfully used for simulation training in a number of surgical specialties. Here we present our experience of the first use of Thiel cadavers in a formal ureteroscopy training course.Material and methodsThe inaugural ‘Masterclass in Flexible Ureterorenoscopy’ was run with participants performing ureterorenoscopy on three Thiel cadavers under expert supervision. A qualitative questionnaire was delivered to the participants and faculty. Assessed domains were tissue characteristics of the cadaveric urinary tract, anatomical features and procedural aspects. A five-point Likert score was used to assess responses. Data regarding participant experience in endourology were also collected.Results8 questionnaires were collected. All participants completed cadaveric ureterorenoscopy. Three-quarters reported the overall quality of tissue in the cadaveric bladder, ureters and pelvicalyceal system as high or excellent. Half reported the cadaveric bladder as being softer than in a live patient, whilst five out of eight thought that the cadaveric ureter was softer and more prone to trauma. Seven out of eight were satisfied with the overall quality of the cadaveric model. The quality of vision and irrigation in the upper urinary tracts was reported as high.ConclusionsThiel cadavers have been shown to have excellent tissue characteristics, as well as being durable and reusable. We have described the first use of Thiel cadavers in a designated ureterorenoscopy course, with high levels of delegate satisfaction. Further work is required to develop the role of Thiel cadavers as part of an integrated, modular urology training.

Optimizing the Timing of Expert Feedback During Simulation-Based Spaced Practice of Endourologic Skills.

Provision of expert feedback is widely acknowledged to be an essential component of simulation-based training. However, little is known about the most effective and efficient ways to provide feedback to novices. Optimizing the timing of expert feedback may improve outcomes while reducing resource requirements. The main objective of this study was to determine the impact of providing early versus late expert feedback to novice learners engaged in a flexible ureteroscopy (fURS) training curriculum. Senior medical students were recruited to participate in this study. Each student participated in a comprehensive fURS training curriculum that included 3 deliberate, independent practice sessions. Baseline and postcourse fURS skill was assessed for each student using a standardized fURS test task. Each student was randomized to either an early feedback group (EFG) or late feedback group (LFG). The EFG participants were provided expert feedback immediately after the baseline skill test, whereas LFG participants were given feedback before their final deliberate, independent practice session. Eighteen senior medical students completed the study (9 EFG and 9 LFG participants). There were no discernible demographic differences between the groups at baseline. When controlling for pretest performance, early rather than late feedback was associated with both shorter postcourse time to completion of the task (19.2 vs. 21.5 minutes, P < 0.01) and higher performance scores (13.1 vs. 10.5, P < 0.01). This study offers preliminary evidence that novice learners may benefit more from early feedback when learning a novel skill. Further study is required.

Comprehensive flexible ureteroscopy (FURS) simulator for training in endourology: The K-box model

Over the last two decades there has been an increase in the incidence of kidney stone disease with a simultaneous rise in the use of ureteroscopy for its management [1]. Flexible ureteroscopy training is variable and still largely dependent on high fidelity models and virtual reality (VR) simulation, both of which are expensive and not readily available in many parts of the world. There is also a lack of good quality bench trainers. In a recent survey of endourologists worldwide, flexible ureteroscopy was considered as a first line treatment for stones <2 cm [2]. With this in mind, we have developed a new portable bench-training box model for training in flexible ureteroscopy and endourology. This is a low-cost reusable model for flexible ureteroscopy training allowing the user to manipulate the scope, place a guidewire and access sheath, use a basket to catch/relocate the stone and finally to use a Holmium YAG laser to fragment the stone. K-box The K-box (K – Box®, Porges-Coloplast, France) is a new generation portable bench-training model for flexible ureteroscopy. It is made of polyurethane and consists of 4 independent boxes with each of these boxes representing a different training model with three separate entry and exit points (Figures 1, ​,2).2). It also comes with a ‘tool tray’, which can be used within the boxes for various training exercises. To use the K-box and perform the exercises, the trainees need to have an endoscope, camera system and screen, light source and disposables such as guidewires, access sheaths, baskets and stents. Trainees can familiarize themselves with different flexible ureterscope movements such as pronation/supination, forward/backward movement, scope deflection and grasping/releasing of objects/stones mimicking the movements in the renal pelvicalyceal system. In addition to this, it allows step-by-step guidewire and access sheath placement along with stone fragmentation (Figures 3, ​,4).4). Although the exercises are done with the box closed while the trainee is watching the screen, when a trainee is unsure or lost in the training model they have the option of opening the flap which enables them to see their position (almost being a surrogate for a radiological image/fluoroscopy). The newly designed flexible ureteroscopy training model allows the surgeon to make the specific movements required when performing flexible ureteroscopy in humans. Figure 1 K-box and its components (1.1 – portable K-box, 1.2 – box open (left) and closed (right), 1.3 – tool tray, 1.4 – K-box with water to use with laser for stone fragmentation). Figure 2 K-box with all four boxes with embossed markings (opened view) showing various configurations for manipulation of the objects within it. Figure 3 Step by step technique (3.1 – placement of guidewire, 3.2 – placement of access sheath, 3.3 – placement and manipulation of flexible ureteroscope). Figure 4 Manipulation in the pelvicalyceal system (4.1 – stone basketing with a flexible ureteroscope via the access sheath, 4.2 – movement of object from A to B). These boxes can either be used separately or in combination in any random order. A silicone aerosol spray can be used to make the inside surfaces of K-box smoother to minimize friction. To enable laser use, the K-box can be used with water allowing fragmentation of stones.

Simulation-based flexible ureteroscopy training using a novel ureteroscopy part-task trainer

Simulation-based training (SBT) is being increasingly used for novice trainees as a means of overcoming the early learning curve associated with new surgical skills. We designed a SBT flexible ureteroscopy (fURS) course using a novel inanimate training model (Cook Medical, Bloomington, IN; URS model). We evaluated the course and validated this Cook URS model. A 2-week SBT fURS course was designed for junior level urology trainees at 2 Canadian universities. The curriculum included didactic lectures, hands-on training, independent training sessions with expert feedback, and use of the Cook URS part-task model. Baseline and post-course assessments of trainee fURS skills were conducted using a standardized test task (fURS with basket manipulation of a calyceal stone). Performances were video-recorded and reviewed by 2 blinded experts using a validated assessment device. Fifteen residents (postgraduate years [PGY] 0-3) participated in the course. Of the participants, 80% rated the Cook URS model as realistic (mean = 4.2/5) and 5 endourology experts rated it as useful as a training device (mean = 4.9/5), providing both face and content validity. The mean overall performance scores, task completion times, and passing ratings correlated with trainee clinical fURS experience - demonstrating construct validity for the Cook URS model. The mean post-course task completion times (15.76 vs. 9.37 minutes, p = 0.001) and overall performance scores (19.20 vs. 25.25, p = 0.007) were significantly better than at baseline. Post-course performance was better in all domains assessed by the validated assessment device. This study demonstrates that a SBT curriculum for fURS can lead to improved short-term technical skills among junior level urology residents. The Cook URS model demonstrated good face, content and construct validity.

Flexible ureteroscopy training for surgeons using isolated porcine kidneys in vitro.

BackgroundTo evaluate the feasibility of flexible ureteroscopy training by using isolated porcine kidneys and ureters in vitro.MethodsTwenty young urologists were randomly divided into four groups. Overall performance was assessed based on a global rating scale, pass/fail rating, total time to complete task, learning curve, incidence of trauma, and perforations. The effect of training was determined by comparing their performance in baseline with that in the post-test.ResultsAfter the training, average operation time significantly decreased from 18 ± 3.4 min to 11 ± 1.2 min (P < 0.05). The urologists exhibited a relatively stable performance level after the sixth operation. Significant differences were observed between pre-test and post-test with respect to the global rating scale and the pass/fail rating (P < 0.05). However, the incidence of mucosal trauma and perforations did not change significantly (P = 0.26 and 0.35, respectively).ConclusionsThe isolated porcine kidneys are convenient and intuitive models for young urologists to practice flexible ureteroscopy on.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0067-9) contains supplementary material, which is available to authorized users.

Effectiveness of Uromentor virtual reality simulator in flexible ureteroscopy training for catechumen

Objective To investigate the effectiveness of Uromentor virtual reality simulator in flexible ureteroscopy training for catechumen. Methods Fifty-one catechumen were selected. After 1 hour training of basic operation in Uromentor virtual reality simulator, all trainees performed special-purpose exercise(kidney inspection with flexible ureteroscopy) for 3 hours. Using right kidney inspection, a preliminary assessment for each trainee was made before the special-purpose exercise and data such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and global rating scale (GRS) were recorded.The same assessment was performed once again after the special-purpose exercise (secondary assessment), and data were recorded and compared to the preliminary assessment. Results Each trainee made a significant improvement in flexible ureteroscopic skill after the special-purpose training. The parameters such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and GRS of all trainees in preliminary assessment were 14.63±1.01 min, 8.62±2.67, 51.05%±20.79% and 10.31±2.53, respectively; while in secondary assessment, parameters were 7.71±1.13 min, 1.67±1.23, 98.04%±5.42% and 29.14±3.01, respectively. The differences between the preliminary assessment and the secondary assessment of each parameter were significant (P<0.01). Conclusions The Uromentor virtual reality simulator can improve the trainee′s skills of flexible ureteroscopy. It is a good instrument of the flexible ureteroscopic training for catechumen. Key words: Virtual reality simulator; Flexible ureteroscopy; Training; Computer simulation

MP28-07 FLEXIBLE URETEROSCOPY TRAINING. NEW TOOL OF TWO-PART SILICONE MOLD (CAVITIES) BASED ON REAL HUMAN KIDNEYS ENDOCASTS

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2015MP28-07 FLEXIBLE URETEROSCOPY TRAINING. NEW TOOL OF TWO-PART SILICONE MOLD (CAVITIES) BASED ON REAL HUMAN KIDNEYS ENDOCASTS Bruno Marroig, Marco Pereira Sampaio, Luciano Favorito, and Francisco Sampaio Bruno MarroigBruno Marroig More articles by this author , Marco Pereira SampaioMarco Pereira Sampaio More articles by this author , Luciano FavoritoLuciano Favorito More articles by this author , and Francisco SampaioFrancisco Sampaio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1230AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Flexible ureteroscopy is a common procedure nowadays. Most of the training programs use virtual reality simulators. The aim of this study was to standardize the building of a three-dimensional silicone mold (cavity) of the collecting system, based on polyester resin endocasts, which can be used in surgical training programs. METHODS A yellow polyester resin was injected into the ureter to fill the collecting system of 10 cadaveric fresh human kidneys. After setting off the resin, the kidneys were immersed in hydrochloric acid until total corrosion of the organic matter was achieved and the collecting system endocasts obtained. The endocasts were used to prepare white color two-part silicone molds, which after endocasts withdrawn, enabled an ureteroscope insertion into the collecting system molds (cavities). Also, the minor calices were painted with different colors in order to map the access to the different caliceal groups. RESULTS Flexible ureteroscope could be inserted into all molds and the entire collecting system could be examined. Some anatomical features, as infundibular length, acute angle, and perpendicular minor calices would difficult the access to some minor calices, especially in the lower caliceal group. CONCLUSIONS The two-part silicone mold is feasible, cheap and allows its use for flexible ureteroscopy surgical training. By the first time, it is presented a training-model made from actual intra-renal collecting system cavities after endocasts. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e313 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruno Marroig More articles by this author Marco Pereira Sampaio More articles by this author Luciano Favorito More articles by this author Francisco Sampaio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Do high-fidelity training models translate into better skill acquisition for an endourologist?

Nowadays, accessibility to the operative room is becoming more limited for medical students and residents, principally due to decreasing operative time, increasing waiting list, ethical consideration and legal issue in case of any complications. Simulation models have gained in popularity and are now considered a major component in the training and skill development of medical students and residents before coming to the operative room. In this review, we summarized and discussed the relevant aspect of ureteroscopy training models and gave an overview of the advantage in skill acquisition while training with a high-fidelity model. Currently, there is an increase in surgical programs trying to implement endourology training models into the curriculum. The training simulators that would allow the medical students and residents to rapidly reach an autonomous level are yet to be developed. Several ureteroscopy models have been described and validated; however, the transposition of skill acquisition into real-life surgery is not properly demonstrated. Training reduces the learning curve for novice medical students or residents. However, further studies are still needed to better define the impact of skill acquisition in real life and its sustainability.

Tips and tricks of ureteroscopy: consensus statement Part I. Basic ureteroscopy.

Ureteroscopy is fast becoming the first line treatment option for the majority of urinary tract stones. Ureteroscopy training can be performed in a variety of ways including simulation, hands on ureteroscopy courses and supervised operative experience. We report an “expert consensus view” from experienced endourological surgeons, on all aspects of basic ureteroscopic techniques, with a particular focus on avoiding and getting out of trouble while performing ureteroscopy. In this paper we provide a summary of treatment planning, positioning, cannulation of ureteric orifice, guidewire placement, rigid ureteroscopy and stone fragmentation.

Simulation-Based Ureteroscopy Training: A Systematic Review

Simulation is a common adjunct to operative training and various modalities exist for ureteroscopy. This systematic review aims the following: (1) to identify available ureteroscopy simulators, (2) to explore evidence for their effectiveness using characteristic criterion, and (3) to provide recommendations for simulation-based ureteroscopy training. The preferred reporting items for systematic reviews and meta-analysis statement guidelines were used. A literature search was performed using the PubMed, EMBASE, and Cochrane Library databases. In total, 20 articles concerning ureteroscopy simulators were included. Overall, 3 high-fidelity bench models are available. The Uro-Scopic Trainer has demonstrated face, construct, and concurrent validity, whereas the Scope Trainer has undergone content, construct, and predictive validation. The adult ureteroscopy trainer has demonstrated face, content, and construct validity. The URO Mentor is the only available ureteroscopy virtual-reality system; 10 studies were identified demonstrating its face, content, construct, concurrent, and predictive validity. The Uro-Scopic Trainer, the Scope Trainer, and the URO Mentor have demonstrated high educational impact. A noncommercially available, low-fidelity model has demonstrated effectiveness comparable to its high-fidelity counterpart at 185 times lesser than the price of the Uro-Scopic Trainer. The use of porcine models has also been described in 3 studies but require further study. Valid models are available for simulation-based ureteroscopy training. However, there is a lack of many high-level studies conducted, and further investigation is required in this area. Furthermore, current research focuses on the technical skills acquisition with little research conducted on nontechnical skills acquisition within ureteroscopy. The next step for ureteroscopy training is a formalized and validated curriculum, incorporating simulation, training models, development of nontechnical skills, and real-life practice.

PD6-06 VALIDATION OF A NOVEL INANIMATE URETEROSCOPY TRAINING MODEL AND A SIMULATION-BASED FLEXIBLE URETEROSCOPY TRAINING COURSE

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment I1 Apr 2014PD6-06 VALIDATION OF A NOVEL INANIMATE URETEROSCOPY TRAINING MODEL AND A SIMULATION-BASED FLEXIBLE URETEROSCOPY TRAINING COURSE Andrea Lantz, Udi Blankstein, R.John D'A. Honey, Michael Ordon, Kenneth T. Pace, and Jason Y. Lee Andrea LantzAndrea Lantz More articles by this author , Udi BlanksteinUdi Blankstein More articles by this author , R.John D'A. HoneyR.John D'A. Honey More articles by this author , Michael OrdonMichael Ordon More articles by this author , Kenneth T. PaceKenneth T. Pace More articles by this author , and Jason Y. LeeJason Y. Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.514AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES By creating a low-stakes learning environment that permits deliberate practice and timely feedback, simulation-based training (SBT) modalities have grown in popularity over recent years. The educational value of surgical simulators, however, is only as good as the curriculum in which they are utilized. We designed a simulation-based flexible ureteroscopy (fURS) training course utilizing a novel inanimate training model (Cook® URS model). We set out to evaluate the new curriculum and validate the Cook® URS model. METHODS A SBT curriculum was designed for Jr level (PGY1-3) urology residents at the University of Toronto and included a didactic lecture, focusing on fundamental urolithiasis management principles and basic fURS techniques, a hands-on demonstration of the various instrumentation and skills required for fURS, and 3 independent practice sessions using the Cook® URS model. Both baseline pre-test and post-course assessment of fURS skill was conducted for a standardized task; fURS with basket manipulation of lower pole stone into the upper pole. Performances were video recorded and later reviewed by 2 blinded experts using a validated assessment device. RESULTS A total of 10 residents participated in the fURS course. There was a significant difference in mean pre- and post-course task completion times (15.8 vs 9.4 mins, p<0.01) and performance scores (19.20 vs 25.25, p<0.01). Eighty percent of participants rated the Cook® URS model as realistic (≥4/5, mean=4.20) and 5 independent endourology experts rated the model as useful as a training device (≥4/5, mean=4.90), providing both face and content validity. There was also significant correlation (p<0.05) between prior fURS experience and mean overall performance scores, task completion times, passing ratings, movement efficiency, instrument handling, and flow of procedure scores (Figure 1), demonstrating construct validity for the Cook® URS model. The fURS global rating scale demonstrated good reliability, (Cronbach’s alpha = 0.848). CONCLUSIONS Our study demonstrated that a SBT curriculum for fURS can lead to improved short-term technical skills amongst Jr level urology residents. The Cook® URS model demonstrated face, content and construct validity. Further study is required. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e132 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Andrea Lantz More articles by this author Udi Blankstein More articles by this author R.John D'A. Honey More articles by this author Michael Ordon More articles by this author Kenneth T. Pace More articles by this author Jason Y. Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD6-07 AUGMENTED REALITY VIDEO SIMULATION FOR ROBOTIC PARTIAL NEPHRECTOMY SURGERY TRAINING – THE NEXT GENERATION

INTRODUCTION AND OBJECTIVES: By creating a low-stakes learning environment that permits deliberate practice and timely feedback, simulation-based training (SBT) modalities have grown in popularity over recent years. The educational value of surgical simulators, however, is only as good as the curriculum in which they are utilized. We designed a simulation-based flexible ureteroscopy (fURS) training course utilizing a novel inanimate training model (Cook URS model). We set out to evaluate the new curriculum and validate the Cook URS model. METHODS: A SBT curriculum was designed for Jr level (PGY1-3) urology residents at the University of Toronto and included a didactic lecture, focusing on fundamental urolithiasis management principles and basic fURS techniques, a hands-on demonstration of the various instrumentation and skills required for fURS, and 3 independent practice sessions using the Cook URS model. Both baseline pre-test and post-course assessment of fURS skill was conducted for a standardized task; fURS with basket manipulation of lower pole stone into the upper pole. Performances were video recorded and later reviewed by 2 blinded experts using a validated assessment device. RESULTS: A total of 10 residents participated in the fURS course. There was a significant difference in mean preand post-course task completion times (15.8 vs 9.4 mins, p<0.01) and performance scores (19.20 vs 25.25, p<0.01). Eighty percent of participants rated the Cook URS model as realistic ( 4/5, mean1⁄44.20) and 5 independent endourology experts rated the model as useful as a training device ( 4/5, mean1⁄44.90), providing both face and content validity. There was also significant correlation (p<0.05) between prior fURS experience and mean overall performance scores, task completion times, passing ratings, movement efficiency, instrument handling, and flow of procedure scores (Figure 1), demonstrating construct validity for the Cook URS model. The fURS global rating scale demonstrated good reliability, (Cronbach’s alpha 1⁄4 0.848). CONCLUSIONS: Our study demonstrated that a SBT curriculum for fURS can lead to improved short-term technical skills amongst Jr level urology residents. The Cook URS model demonstrated face, content and construct validity. Further study is required. Source of Funding: none

Role of Active Mentoring During Flexible Ureteroscopy Training

To evaluate the outcome of flexible ureteroscopy training with or without an active mentor. Thirty-six flexible ureteroscopy naive practicing urologists and urology residents, after an initial introductory refreshment course, underwent training under a mentor for 15 minutes each in a high-fidelity nonvirtual reality Endo-Urologie-Modell (Karl Storz). The trainees were then randomized into two equal groups for training: One under a mentor and the other without. These two groups completed the training for 2 hours. Global rating scale (GRS) for the performance of flexible ureteroscopy was measured by a blinded expert at the beginning and end of the training. A specific task completion time (TCT) was noted at the end of the training. The trainees noted their own global rating scale at the end of the training. The GRS by the expert at the end of the training was significantly higher in the mentor group. TCT was significantly lower in the mentor group. TCT correlated well with the GRS as measured by the expert rather than the trainee. Mentorship during flexible ureteroscopy training results in higher GRS and lower TCT at the end of the training. Self-assessment GRS by trainee does not correlate well with the skills acquired.

Use of High Fidelity Operating Room Simulation to Assess and Teach Communication, Teamwork and Laparoscopic Skills: Initial Experience

Structured opportunities for learning communication, teamwork and laparoscopic principles are limited for urology residents. We evaluated and taught teamwork, communication and laparoscopic skills to urology residents in a simulated operating room. Scenarios related to laparoscopy (insufflator failure, carbon dioxide embolism) were developed using mannequins, urology residents and nurses. These scenarios were developed based on Accreditation Council for Graduate Medical Education core competencies and performed in a simulation center. Between the pretest scenario (insufflation failure) and the posttest scenario (carbon dioxide embolism) instruction was given on teamwork, communication and laparoscopic skills. A total of 19 urology residents participated in the training that involved participation in at least 2 scenarios. Performance was evaluated using validated teamwork instruments, questionnaires and videotape analysis. Significant improvement was noted on validated teamwork instruments between scenarios based on resident (pretest 24, posttest 27, p = 0.01) and expert (pretest 16, posttest 25, p = 0.008) evaluation. Increased teamwork and team performance were also noted between scenarios on videotape analysis with significant improvement for adherence to best practice (p = 0.01) and maintenance of positive rapport among team members (p = 0.02). Significant improvement in the setup of the laparoscopic procedure was observed (p = 0.01). Favorable face and content validity was noted for both scenarios. Teamwork, intraoperative communication and laparoscopic skills of urology residents improved during the high fidelity simulation course. Face and content validity of the individual sessions was favorable. In this study high fidelity simulation was effective for assessing and teaching Accreditation Council for Graduate Medical Education core competencies related to intraoperative communication, teamwork and laparoscopic skills.