ENDOUROLOGY & LAPAROSCOPY

Randomized prospective blinded study validating acquisition of ureteroscopy skills using computer based virtual reality endourological simulator
Watterson JD, Beiko DT, Kuan JK, Denstedt JD
J Urol. 2002; 168:1928-32

• Purpose: Surgical simulation has emerged in the last decade as a potential tool for aiding acquisition of technical skills, including anesthesia protocols, trauma management, cardiac catheterization and laparoscopy. We evaluate and validate the use of a computer based ureteroscopy simulator (URO Mentor, Simbionix Ltd., Lod, Israel) in the acquisition of basic ureteroscopic skills.
• Materials and Methods: We assessed 20 novice trainees for the ability to perform basic ureteroscopic tasks on a computer based ureteroscopy simulator. Participants were randomized to receive individualized mentored instruction or no additional training, and subsequently underwent post-testing. Pre-training and post-training improvement in performance was assessed by objective simulator based measurements. Subjective overall performance was rated using a validated endourological global rating scale by an observer blinded to subject training status.
• Results: Demographics and pre-test scores were similar between groups. Post-testing revealed a significant effect of training on objective and subjective measurements. Spearman rank correlation demonstrated a significant association between objective simulator based measurements and the endourological global rating scale.
• Conclusions: Use of a computer based ureteroscopy simulator resulted in rapid acquisition of ureteroscopic skills in trainees with no prior surgical training. Results of this study demonstrate the use of a virtual reality ureteroscopy simulator in endourological training. Correlation of simulator based measurements with a previously validated endourological global rating scale provides initial validation of the ureteroscopy simulator for the assessment of ureteroscopic skills.
  
  
• Editorial Comment
  It has been fascinating to follow the development of surgical simulators over the past few years. Initially very crude, these devices have steadily improved. Technology that has any potential for consumer product development tends to be introduced and refined in the consumer market before resources are directed to the health care market. In this regard, the first surgical simulators (in the 90s) looked like 70s computer arcade games, whereas the current crop of simulators have closed the gap – such that they might be compared to 3D graphics games for personal computers from just a few years ago. Along with improvements in graphics, the utility of the simulators in terms of situational elements have improved. This study by Watterson and associates illustrates at the very least that motor skills on the device can be improved with only a short training period, and that such improvement can be measured with validated instruments. This is an excellent first step, but there are many more important questions to be addressed: Do skills on the simulator translate into skills in the operating room? How long do benefits of the training last? How long will it take for untrained students to catch up to the trained ones with subsequent clinical experience? What are the trade-offs of time, expense, and surgical risk that are made if surgical simulators are used to replace or augment some portions of “apprenticeship” surgical training? It seems very likely that surgical simulators will play some role in training in the future, but many more issues need to be worked out.

Dr. J. Stuart Wolf Jr.
Associate Professor of Urology
University of Michigan
Ann Arbor, Michigan, USA