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Published in: Current Urology Reports 11/2023

22-09-2023

Recent Advances in Surgical Simulation For Resident Education

Authors: Christopher Wanderling, Aaron Saxton, Dennis Phan, Lauren Sheppard, Nathan Schuler, Ahmed Ghazi

Published in: Current Urology Reports | Issue 11/2023

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Abstract

Purpose of Review

Surgical simulation has become a cornerstone for the training of surgical residents, especially for urology residents. Urology as a specialty bolsters a diverse range of procedures requiring a variety of technical skills ranging from open and robotic surgery to endoscopic procedures. While hands-on supervised training on patients still remains the foundation of residency training and education, it may not be sufficient to achieve proficiency for graduation even if case minimums are achieved. It has been well-established that simulation-based education (SBE) can supplement residency training and achieve the required proficiency benchmarks.

Recent Findings

Low-fidelity modules, such as benchtop suture kits or laparoscopic boxes, can establish a strong basic skills foundation. Eventually, residents progress to high-fidelity models to refine application of technical skills and improve operative performance. Human cadavers and animal models remain the gold standard for procedural SBE. Recently, given the well-recognized financial and ethical costs associated with cadaveric and animal models, residency programs have shifted their investments toward virtual and more immersive simulations.

Summary

Urology as a field has pushed the boundaries of SBE and has reached a level where unexplored modalities, e.g., 3D printing, augmented reality, and polymer casting, are widely utilized for surgical training as well as preparation for challenging cases at both the residents, attending and team training level.
Literature
3.
go back to reference Schwab B, et al. The role of simulation in surgical education. J Laparoendosc Adv Surg Tech A. 2017;27(5):450–4.CrossRefPubMed Schwab B, et al. The role of simulation in surgical education. J Laparoendosc Adv Surg Tech A. 2017;27(5):450–4.CrossRefPubMed
4.
go back to reference Kincaid JP, Donovan J, Pettitt B. Simulation techniques for training emergency response. Int J Emerg Med. 2003;1:238–46. Kincaid JP, Donovan J, Pettitt B. Simulation techniques for training emergency response. Int J Emerg Med. 2003;1:238–46.
5.
go back to reference •• Kozan AA, Chan LH, Biyani CS. Current status of simulation training in urology: a non-systematic review. Res Rep Urol. 2020;12:111-12/. https://doi.org/10.2147/RRU.S237808. PMID: 32232016; PMCID: PMC7085342. This review article highlights recent advances in surgical simulation focused on urology and is highly important. •• Kozan AA, Chan LH, Biyani CS. Current status of simulation training in urology: a non-systematic review. Res Rep Urol. 2020;12:111-12/. https://​doi.​org/​10.​2147/​RRU.​S237808. PMID: 32232016; PMCID: PMC7085342. This review article highlights recent advances in surgical simulation focused on urology and is highly important.
6.
go back to reference Raemer D. Society for simulation in healthcare. In: Riley RH, editor. Manual of Simulation in Healthcare, Chpt. 38. Oxford: Oxford University Press; 2008. p. 529–32. ISBN 978–0–19- 920585–1. Raemer D. Society for simulation in healthcare. In: Riley RH, editor. Manual of Simulation in Healthcare, Chpt. 38. Oxford: Oxford University Press; 2008. p. 529–32. ISBN 978–0–19- 920585–1.
8.
go back to reference •• Pelly T, et al. Low-cost simulation models in urology: a systematic review of the literature. Cent European J Urol. 2020;73(3):373–80. This review highlights low cost or low-fidelity models for urology simulation education. •• Pelly T, et al. Low-cost simulation models in urology: a systematic review of the literature. Cent European J Urol. 2020;73(3):373–80. This review highlights low cost or low-fidelity models for urology simulation education.
10.
go back to reference •• Canalichio KL, Berrondo C, Lendvay TS. Simulation training in urology: state of the art and future directions. Adv Med Educ Pract. 2020;11:391–6. This article highlights current and possible future directions of surgical simulation for urologic education and training. •• Canalichio KL, Berrondo C, Lendvay TS. Simulation training in urology: state of the art and future directions. Adv Med Educ Pract. 2020;11:391–6. This article highlights current and possible future directions of surgical simulation for urologic education and training.
11.
go back to reference Dawe SR, et al. Systematic review of skills transfer after surgical simulation-based training. Br J Surg. 2014;101(9):1063–76.CrossRefPubMed Dawe SR, et al. Systematic review of skills transfer after surgical simulation-based training. Br J Surg. 2014;101(9):1063–76.CrossRefPubMed
12.
go back to reference Sethi AS, et al. Validation of a novel virtual reality robotic simulator. J Endourol. 2009;23(3):503–8.CrossRefPubMed Sethi AS, et al. Validation of a novel virtual reality robotic simulator. J Endourol. 2009;23(3):503–8.CrossRefPubMed
15.
go back to reference Lentz AC, Rodríguez D, Chandrapal JC, Davis LG, Ghazi A, Gross MS, Munarriz R. Cadaveric laboratory simulation training of male stress urinary incontinence treatment improves trainee knowledge and confidence. Urology. 2020;143:48–54.CrossRefPubMed Lentz AC, Rodríguez D, Chandrapal JC, Davis LG, Ghazi A, Gross MS, Munarriz R. Cadaveric laboratory simulation training of male stress urinary incontinence treatment improves trainee knowledge and confidence. Urology. 2020;143:48–54.CrossRefPubMed
16.
go back to reference •• Ghazi A. A call for change. Can 3D printing replace cadavers for surgical training? Urol Clin North Am. 2022;49(1):39–56. This project evaluates the utility of synthetic models replacing the costly and ethically challenging problems of cadaveric training modalities. •• Ghazi A. A call for change. Can 3D printing replace cadavers for surgical training? Urol Clin North Am. 2022;49(1):39–56. This project evaluates the utility of synthetic models replacing the costly and ethically challenging problems of cadaveric training modalities.
17.
go back to reference Carey JN, et al. Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthet Surg. 2014;67(2):e42–8.CrossRefPubMed Carey JN, et al. Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthet Surg. 2014;67(2):e42–8.CrossRefPubMed
18.
go back to reference Yiasemidou M, et al. Cadaveric simulation: a review of reviews. Ir J Med Sci. 2018;187(3):827–33.CrossRefPubMed Yiasemidou M, et al. Cadaveric simulation: a review of reviews. Ir J Med Sci. 2018;187(3):827–33.CrossRefPubMed
19.
go back to reference Sharma M, Macafee D, Horgan AF. Basic laparoscopic skills training using fresh frozen cadaver: a randomized controlled trial. Am J Surg. 2013;206(1):23–31.CrossRefPubMed Sharma M, Macafee D, Horgan AF. Basic laparoscopic skills training using fresh frozen cadaver: a randomized controlled trial. Am J Surg. 2013;206(1):23–31.CrossRefPubMed
22.
go back to reference Farhan B, et al. Face, content, and construct validations of endoscopic needle injection simulator for transurethral bulking agent in treatment of stress urinary incontinence. J Surg Educ. 2018;75(6):1673–8.CrossRefPubMed Farhan B, et al. Face, content, and construct validations of endoscopic needle injection simulator for transurethral bulking agent in treatment of stress urinary incontinence. J Surg Educ. 2018;75(6):1673–8.CrossRefPubMed
24.
25.
go back to reference Childs BS, Manganiello MD, Korets R. Novel education and simulation tools in urologic training. Curr Urol Rep. 2019;20(12):81.CrossRefPubMed Childs BS, Manganiello MD, Korets R. Novel education and simulation tools in urologic training. Curr Urol Rep. 2019;20(12):81.CrossRefPubMed
26.
go back to reference Analichio KL, Berrondo C, Lendvay TS. Simulation training in urology: state of the art and future directions. Adv Med Educ Pract. 2020;11:391–6.CrossRef Analichio KL, Berrondo C, Lendvay TS. Simulation training in urology: state of the art and future directions. Adv Med Educ Pract. 2020;11:391–6.CrossRef
27.
go back to reference Schulz GB, et al. Benefits and limitations of transurethral resection of the prostate training with a novel virtual reality simulator. Simul Healthc. 2020;15(1):14–20.CrossRefPubMed Schulz GB, et al. Benefits and limitations of transurethral resection of the prostate training with a novel virtual reality simulator. Simul Healthc. 2020;15(1):14–20.CrossRefPubMed
28.
go back to reference Brewin J, et al. Face, content, and construct validation of the Bristol TURP trainer. J Surg Educ. 2014;71(4):500–5.CrossRefPubMed Brewin J, et al. Face, content, and construct validation of the Bristol TURP trainer. J Surg Educ. 2014;71(4):500–5.CrossRefPubMed
29.
go back to reference Schout BM, Ananias HJ, Bemelmans BL, et al. Transfer of cysto-urethroscopy skills from a virtual- reality simulator to the operating room: a randomized controlled trial. BJU Int. 2010;106:226.CrossRefPubMed Schout BM, Ananias HJ, Bemelmans BL, et al. Transfer of cysto-urethroscopy skills from a virtual- reality simulator to the operating room: a randomized controlled trial. BJU Int. 2010;106:226.CrossRefPubMed
30.
go back to reference Schulz GB, et al. Validation of a high-end virtual reality simulator for training transurethral resection of bladder tumors. J Surg Educ. 2019;76(2):568–77.CrossRefPubMed Schulz GB, et al. Validation of a high-end virtual reality simulator for training transurethral resection of bladder tumors. J Surg Educ. 2019;76(2):568–77.CrossRefPubMed
31.
go back to reference Tjiam IM, et al. Evaluation of the educational value of a virtual reality TURP simulator according to a curriculum-based approach. Simul Healthc. 2014;9(5):288–94.CrossRefPubMed Tjiam IM, et al. Evaluation of the educational value of a virtual reality TURP simulator according to a curriculum-based approach. Simul Healthc. 2014;9(5):288–94.CrossRefPubMed
32.
go back to reference Hudak SJ, et al. External validation of a virtual reality transurethral resection of the prostate simulator. J Urol. 2010;184(5):2018–22.CrossRefPubMed Hudak SJ, et al. External validation of a virtual reality transurethral resection of the prostate simulator. J Urol. 2010;184(5):2018–22.CrossRefPubMed
33.
go back to reference Ahmed K, Jawad M, Dasgupta P, Darzi A, Athanasiou T, Khan MS. Assessment and maintenance of competence in urology. Nat Rev Urol. 2010;7:403–13.CrossRefPubMed Ahmed K, Jawad M, Dasgupta P, Darzi A, Athanasiou T, Khan MS. Assessment and maintenance of competence in urology. Nat Rev Urol. 2010;7:403–13.CrossRefPubMed
34.
35.
go back to reference Knudsen BE, Matsumoto ED, Chew BH, et al. A randomized, controlled, prospective study validating the acquisition of percutaneous renal collecting system access skills using a computer based hybrid virtual reality surgical simulator: Phase I. J Urol. 2006;176:2173–8.CrossRefPubMed Knudsen BE, Matsumoto ED, Chew BH, et al. A randomized, controlled, prospective study validating the acquisition of percutaneous renal collecting system access skills using a computer based hybrid virtual reality surgical simulator: Phase I. J Urol. 2006;176:2173–8.CrossRefPubMed
36.
go back to reference Mishra S, Kurien A, Patel R, Patil P, Ganpule A, Muthu V, Sabnis RB, Desai M. Validation of virtual reality simulation for percutaneous renal access training. J Endourol. 2010;24:635–40.CrossRefPubMed Mishra S, Kurien A, Patel R, Patil P, Ganpule A, Muthu V, Sabnis RB, Desai M. Validation of virtual reality simulation for percutaneous renal access training. J Endourol. 2010;24:635–40.CrossRefPubMed
38.
go back to reference Al Janabi HF, et al. Effectiveness of the HoloLens mixed-reality headset in minimally invasive surgery: a simulation-based feasibility study. Surg Endosc. 2020;34(3):1143–9.CrossRefPubMed Al Janabi HF, et al. Effectiveness of the HoloLens mixed-reality headset in minimally invasive surgery: a simulation-based feasibility study. Surg Endosc. 2020;34(3):1143–9.CrossRefPubMed
39.
go back to reference Neumann E, et al. Transurethral resection of bladder tumors: next-generation virtual reality training for surgeons. Eur Urol Focus. 2019;5(5):906–11.CrossRefPubMed Neumann E, et al. Transurethral resection of bladder tumors: next-generation virtual reality training for surgeons. Eur Urol Focus. 2019;5(5):906–11.CrossRefPubMed
42.
go back to reference Komai Y, et al. A novel 3-dimensional image analysis system for case-specific kidney anatomy and surgical simulation to facilitate clampless partial nephrectomy. Urology. 2014;83(2):500–6.CrossRefPubMed Komai Y, et al. A novel 3-dimensional image analysis system for case-specific kidney anatomy and surgical simulation to facilitate clampless partial nephrectomy. Urology. 2014;83(2):500–6.CrossRefPubMed
43.
go back to reference Silberstein JL, et al. Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers: a pilot study. Urology. 2014;84(2):268–72.CrossRefPubMed Silberstein JL, et al. Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers: a pilot study. Urology. 2014;84(2):268–72.CrossRefPubMed
44.
go back to reference Adams F, Qiu T, Mark A, Fritz B, Kramer L, Schlager D, Wetterauer U, Miernik A, Fischer P. Soft 3D-Printed phantom of the human kidney with collecting system. Ann Biomed Eng. 2017;45(4):963–972. https://doi.org/10.1007/s10439-016-1757-5. Epub 2016 Nov 9. PMID: 27830490; PMCID: PMC5362658. Adams F, Qiu T, Mark A, Fritz B, Kramer L, Schlager D, Wetterauer U, Miernik A, Fischer P. Soft 3D-Printed phantom of the human kidney with collecting system. Ann Biomed Eng. 2017;45(4):963–972. https://​doi.​org/​10.​1007/​s10439-016-1757-5. Epub 2016 Nov 9. PMID: 27830490; PMCID: PMC5362658.
45.
go back to reference Melnyk R, Ezzat B, Belfast E, Saba P, Farooq S, Campbell T, et al. Mechanical and functional validation of a perfused, robot-assisted partial nephrectomy simulation platform using a combination of 3D printing and hydrogel casting. World J Urol. 2019. https://doi.org/10.1007/s00345-019-02989-z. Melnyk R, Ezzat B, Belfast E, Saba P, Farooq S, Campbell T, et al. Mechanical and functional validation of a perfused, robot-assisted partial nephrectomy simulation platform using a combination of 3D printing and hydrogel casting. World J Urol. 2019. https://​doi.​org/​10.​1007/​s00345-019-02989-z.
46.
go back to reference Ghazi A, Melnyk R, Hung A, Collins J, Ertefaie A, Saba P, Gurung P, Frye T, Mottrie A, Costello T, Dasgupta P, Joseph J. Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS). BJU Int. 2020. https://doi.org/10.1111/bju.15246. Epub ahead of print. PMID: 32936977. Ghazi A, Melnyk R, Hung A, Collins J, Ertefaie A, Saba P, Gurung P, Frye T, Mottrie A, Costello T, Dasgupta P, Joseph J. Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS). BJU Int. 2020. https://​doi.​org/​10.​1111/​bju.​15246. Epub ahead of print. PMID: 32936977.
47.
go back to reference Witthaus MW, Farooq S, Melnyk R, Campbell T, Saba P, Mathews E, et al. Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full-immersion simulation platform for nerve-sparing robot-assisted radical prostatectomy (NS-RARP) utilizing three-dimensional printing and hydrogel casting technology. BJU Int. 2019;125:322–32. https://doi.org/10.1111/bju.14940.CrossRefPubMed Witthaus MW, Farooq S, Melnyk R, Campbell T, Saba P, Mathews E, et al. Incorporation and validation of clinically relevant performance metrics of simulation (CRPMS) into a novel full-immersion simulation platform for nerve-sparing robot-assisted radical prostatectomy (NS-RARP) utilizing three-dimensional printing and hydrogel casting technology. BJU Int. 2019;125:322–32. https://​doi.​org/​10.​1111/​bju.​14940.CrossRefPubMed
48.
go back to reference Saba P, Belfast E, Melnyk R, Patel A, Kashyap R, Ghazi A. Development of a high-fidelity robotic assisted kidney transplant (RAKT) simulation platform using 3D printing and hydrogel casting technologies. J Endourol. 2020. Epub 2020 Jun 27. Saba P, Belfast E, Melnyk R, Patel A, Kashyap R, Ghazi A. Development of a high-fidelity robotic assisted kidney transplant (RAKT) simulation platform using 3D printing and hydrogel casting technologies. J Endourol. 2020. Epub 2020 Jun 27.
51.
go back to reference Raison N, Harrison P, Abe T, Aydin A, Ahmed K, Dasgupta P. Procedural virtual reality simulation training for robotic surgery: a randomised controlled trial. Surg Endosc. 2021;35(12):6897–6902. https://doi.org/10.1007/s00464-020-08197-w. Epub 2021 Jan 4. PMID: 33398587; PMCID: PMC8599326. Raison N, Harrison P, Abe T, Aydin A, Ahmed K, Dasgupta P. Procedural virtual reality simulation training for robotic surgery: a randomised controlled trial. Surg Endosc. 2021;35(12):6897–6902. https://​doi.​org/​10.​1007/​s00464-020-08197-w. Epub 2021 Jan 4. PMID: 33398587; PMCID: PMC8599326.
52.
go back to reference Sainsbury B, Łącki M, Shahait M, Goldenberg M, Baghdadi A, Cavuoto L, Ren J, Green M, Lee J, Averch TD, Rossa C. Evaluation of a virtual reality percutaneous nephrolithotomy (PCNL) surgical simulator. Front Robot AI. 2020;14(6):145. https://doi.org/10.3389/frobt.2019.00145. PMID: 33501160; PMCID: PMC7805868. Sainsbury B, Łącki M, Shahait M, Goldenberg M, Baghdadi A, Cavuoto L, Ren J, Green M, Lee J, Averch TD, Rossa C. Evaluation of a virtual reality percutaneous nephrolithotomy (PCNL) surgical simulator. Front Robot AI. 2020;14(6):145. https://​doi.​org/​10.​3389/​frobt.​2019.​00145. PMID: 33501160; PMCID: PMC7805868.
53.
go back to reference Marr B. The important difference between virtual reality, augmented reality and mixed reality. Forbes. 2019. Marr B. The important difference between virtual reality, augmented reality and mixed reality. Forbes. 2019.
56.
go back to reference Rojas-Muñoz E, et al. Surgical telementoring without encumbrance: a comparative study of see-through augmented reality-based approaches. Ann Surg. 2019;270(2):384–9.CrossRefPubMed Rojas-Muñoz E, et al. Surgical telementoring without encumbrance: a comparative study of see-through augmented reality-based approaches. Ann Surg. 2019;270(2):384–9.CrossRefPubMed
58.
go back to reference Ghazi A, Saba P, Shuler N, Shepard L, Witthaus M, Munarriz R. Design of a non-biohazardous simulation model for inflatable penile prosthetic placement using 3D printing technology: a feasibility and utility study for socially distanced education using mixed reality technologies for remote proctoring. Urol Video J. 2022;100193. https://doi.org/10.1016/j.urolvj.2022.100193. ISSN 2590–0897. Ghazi A, Saba P, Shuler N, Shepard L, Witthaus M, Munarriz R. Design of a non-biohazardous simulation model for inflatable penile prosthetic placement using 3D printing technology: a feasibility and utility study for socially distanced education using mixed reality technologies for remote proctoring. Urol Video J. 2022;100193. https://​doi.​org/​10.​1016/​j.​urolvj.​2022.​100193. ISSN 2590–0897.
59.
go back to reference Witthaus MW, Saba P, Melnyk R, Ajay D, Ralph D, Van Renterghem K, Warren G, Munarriz R, Ghazi A. The future of penile prosthetic surgical training is here: design of a hydrogel model for inflatable penile prosthetic placement using modern education theory. J Sex Med. 2020. Epub 2020 Sep 15. Witthaus MW, Saba P, Melnyk R, Ajay D, Ralph D, Van Renterghem K, Warren G, Munarriz R, Ghazi A. The future of penile prosthetic surgical training is here: design of a hydrogel model for inflatable penile prosthetic placement using modern education theory. J Sex Med. 2020. Epub 2020 Sep 15.
60.
go back to reference Ghazi A, Melnyk R, Melnyk J, Jain R, Quarrier S, et al. Design and validation of a non-biohazardous simulation model for holmium laser enucleation of the prostate (HOLEP). J Urol. 2022;207:Supplement 5. Ghazi A, Melnyk R, Melnyk J, Jain R, Quarrier S, et al. Design and validation of a non-biohazardous simulation model for holmium laser enucleation of the prostate (HOLEP). J Urol. 2022;207:Supplement 5.
Metadata
Title
Recent Advances in Surgical Simulation For Resident Education
Authors
Christopher Wanderling
Aaron Saxton
Dennis Phan
Lauren Sheppard
Nathan Schuler
Ahmed Ghazi
Publication date
22-09-2023
Publisher
Springer US
Published in
Current Urology Reports / Issue 11/2023
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-023-01178-1

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