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01-05-2022 | Transurethral Prostate Resection | Invited Review

Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology

Authors: Theodoros Tokas, Gernot Ortner, Angelis Peteinaris, Bhaskar Kumar Somani, Thomas Herrmann, Udo Nagele, Domenico Veneziano, Ali Serdar Gözen, Panagiotis Kallidonis

Published in: World Journal of Urology | Issue 5/2022

Abstract

Purpose

Transurethral resection (TURP) and photoselective vaporization of the prostate (PVP) constitute established surgical options to treat benign prostate hyperplasia. We investigated the current literature for simulators that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum.

Methods

A literature search was performed using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials—CENTRAL. Search terms included: Simulat*, train*, curricull*, transurethral, TUR*, vaporesect*, laser. The efficacy of different simulators and the impact of different devices, curricula and courses in training and trainee learning curves were the primary endpoints.

Results

Thirty-one studies are selected and presented. Validated virtual reality TURP simulators are the UW VR, PelvicVision, Uro-Trainer, and TURPsim™. Validated synthetic TURP models are Dr. K. Forke's TURP trainer, Bristol TURP trainer, different tissue prostate models, and 3D-printed phantoms. The Myo Sim PVP and the GreenLightTM are sufficiently validated PVP simulators. Several TURP and PVP training curricula have been developed and judged as applicable. Finally, the TURP modules of the European Urology Residents Education Programme (EUREP) Hands-on Training course and the Urology Simulation Bootcamp Course (USBC) are the most basic annual TURP courses identified in the international literature.

Conclusions

Simulators and courses or curricula are valuable learning and training TURP/PVP tools. The existent models seem efficient, are not always adequately evaluated and accepted. As part of training curricula and training courses, the use of training simulators can significantly improve quality for young urologists' education and clinical practice.

Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P (2011) Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int 108(7):1132–1138. https://doi.org/10.1111/j.1464-410X.2010.09993.xCrossRefPubMed

Zang YC, Deng XX, Yang DR, Xue BX, Xu LJ, Liu XL, Zhou YB, Shan YX (2016) Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials. Lasers Med Sci 31(2):235–240. https://doi.org/10.1007/s10103-015-1843-1CrossRefPubMed

Liberale F, Muir GH, Walsh K, Krishnamoorthy R (2011) GreenLight laser prostatectomy: a safe and effective treatment for bladder outlet obstruction by prostate cancer. BJU Int 107(5):772–776. https://doi.org/10.1111/j.1464-410X.2010.09584.xCrossRefPubMed

Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58(3):384–397. https://doi.org/10.1016/j.eururo.2010.06.005CrossRefPubMed

Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017CrossRefPubMed

Malek RS, Kuntzman RS, Barrett DM (2005) Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol 174(4 Pt 1):1344–1348. https://doi.org/10.1097/01.ju.0000173913.41401.67CrossRefPubMed

Cameron JL (1997) William Stewart Halsted. Our surgical heritage. Ann Surg 225(5):445–458. https://doi.org/10.1097/00000658-199705000-00002CrossRefPubMedPubMedCentral

Reznick RK, MacRae H (2006) Teaching surgical skills-changes in the wind. N Engl J Med 355(25):2664–2669. https://doi.org/10.1056/NEJMra054785CrossRefPubMed

Kallidonis P, Peteinaris A, Ortner G, Somani BK, Veneziano D, Tunc L, Gözen AS, Liatsikos E, Tokas T (2021) Simulation models and training curricula for training in endoscopic enucleation of the prostate: a systematic review from ESUT. Turk J Urol 47(4):250–259CrossRef

10.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2019) Cochrane handbook for systematic reviews of interventions version 6.0 (updated July 2019). Cochrane. www.training.cochrane.org/handbook

11.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535CrossRefPubMedPubMedCentral

12.

Ballaro A, Briggs T, Garcia-Montes F, MacDonald D, Emberton M, Mundy AR (1999) A computer generated interactive transurethral prostatic resection simulator. J Urol 162(5):1633–1635CrossRef

13.

Brewin J, Ahmed K, Khan MS, Jaye P, Dasgupta P (2014) Face, content, and construct validation of the Bristol TURP trainer. J Surg Educ 71(4):500–505. https://doi.org/10.1016/j.jsurg.2014.01.013CrossRefPubMed

14.

Bright E, Vine S, Wilson MR, Masters RS, McGrath JS (2012) Face validity, construct validity and training benefits of a virtual reality TURP simulator. Int J Surg 10(3):163–166. https://doi.org/10.1016/j.ijsu.2012.02.012CrossRefPubMed

15.

Bright E, Vine SJ, Dutton T, Wilson MR, McGrath JS (2014) Visual control strategies of surgeons: a novel method of establishing the construct validity of a transurethral resection of the prostate surgical simulator. J Surg Educ 71(3):434–439. https://doi.org/10.1016/j.jsurg.2013.11.006CrossRefPubMed

16.

Choi E, Adams F, Palagi S, Gengenbacher A, Schlager D, Müller PF, Gratzke C, Miernik A, Fischer P, Qiu T (2020) A high-fidelity phantom for the simulation and quantitative evaluation of transurethral resection of the prostate. Ann Biomed Eng 48(1):437–446. https://doi.org/10.1007/s10439-019-02361-7CrossRefPubMed

17.

Ebbing J, Schostak M, Steiner U, Stier K, Neymeyer J, Miller K, Baumunk D (2011) Novel low-cost prostate resection trainer-description and preliminary evaluation. Int J Med Robot 7(3):367–373. https://doi.org/10.1002/rcs.407CrossRefPubMed

18.

Hou S, Ross G, Tait I, Halliday P, Tang B (2017) Development and validation of a novel and cost-effective animal tissue model for training transurethral resection of the prostate. J Surg Educ 74(5):898–905. https://doi.org/10.1016/j.jsurg.2017.03.004CrossRefPubMed

19.

Hudak SJ, Landt CL, Hernandez J, Soderdahl DW (2010) External validation of a virtual reality transurethral resection of the prostate simulator. J Urol 184(5):2018–2022. https://doi.org/10.1016/j.juro.2010.06.141CrossRefPubMed

20.

Källström R, Hjertberg H, Kjölhede H, Svanvik J (2005) Use of a virtual reality, real-time, simulation model for the training of urologists in transurethral resection of the prostate. Scand J Urol Nephrol 39(4):313–320. https://doi.org/10.1080/00365590510031246CrossRefPubMed

21.

Källström R, Hjertberg H, Svanvik J (2010) Construct validity of a full procedure, virtual reality, real-time, simulation model for training in transurethral resection of the prostate. J Endourol 24(1):109–115. https://doi.org/10.1089/end.2009.0114CrossRefPubMed

22.

Källström R, Hjertberg H, Svanvik J (2010) Impact of virtual reality-simulated training on urology residents’ performance of transurethral resection of the prostate. J Endourol 24(9):1521–1528. https://doi.org/10.1089/end.2009.0667CrossRefPubMed

23.

Kumar PV, Gomes MP, Davies BL, Timoney AG (2002) A computer assisted surgical trainer for transurethral resection of the prostate. J Urol 168(5):2111–2114. https://doi.org/10.1097/01.ju.0000034468.80053.22CrossRefPubMed

24.

Mishra S, Kurien A, Ganpule A, Veeramani M, Sabnis RB, Desai M (2010) Face and content validity of transurethral resection of prostate on Uro Trainer: is the simulation training useful? J Endourol 24(11):1839–1843. https://doi.org/10.1089/end.2009.0612CrossRefPubMed

25.

Rashid HH, Kowalewski T, Oppenheimer P, Ooms A, Krieger JN, Sweet RM (2007) The virtual reality transurethral prostatic resection trainer: evaluation of discriminate validity. J Urol 177(6):2283–2286. https://doi.org/10.1016/j.juro.2007.01.120CrossRefPubMed

26.

Rasyid N, Putra HWK, Birowo P, Wahyudi I, Mochtar CA, Hamid A (2020) TUR-P phantom for resident surgical training: food-based design as a human mimicking model of the prostate. World J Urol. https://doi.org/10.1007/s00345-020-03085-3CrossRefPubMed

27.

Schout BM, Bemelmans BL, Martens EJ, Scherpbier AJ, Hendrikx AJ (2009) How useful and realistic is the uro trainer for training transurethral prostate and bladder tumor resection procedures? J Urol 181(3):1297–1303. https://doi.org/10.1016/j.juro.2008.10.169 (discussion 1303)CrossRefPubMed

28.

Schulz GB, Grimm T, Kretschmer A, Stief CG, Jokisch F, Karl A (2020) Benefits and limitations of transurethral resection of the prostate training with a novel virtual reality simulator. Simul Healthc 15(1):14–20. https://doi.org/10.1097/sih.0000000000000396CrossRefPubMed

29.

Sweet R, Kowalewski T, Oppenheimer P, Weghorst S, Satava R (2004) Face, content and construct validity of the University of Washington virtual reality transurethral prostate resection trainer. J Urol 172(5 Pt 1):1953–1957. https://doi.org/10.1097/01.ju.0000141298.06350.4cCrossRefPubMed

30.

Tjiam IM, Berkers CH, Schout BM, Brinkman WM, Witjes JA, Scherpbier AJ, Hendrikx AJ, Koldewijn EL (2014) Evaluation of the educational value of a virtual reality TURP simulator according to a curriculum-based approach. Simul Healthc 9(5):288–294. https://doi.org/10.1097/sih.0000000000000041CrossRefPubMed

31.

Zhu H, Zhang Y, Liu JS, Wang G, Yu CF, Na YQ (2013) Virtual reality simulator for training urologists on transurethral prostatectomy. Chin Med J (Engl) 126(7):1220–1223

32.

Angulo JC, Arance I, García-Tello A, Las Heras MM, Andrés G, Gimbernat H, Lista F, Ramón de Fata F (2014) Virtual reality simulator for training on photoselective vaporization of the prostate with 980 nm diode laser and learning curve of the technique. Actas Urol Esp 38(7):451–458. https://doi.org/10.1016/j.acuro.2014.02.013CrossRefPubMed

33.

Aydin A, Muir GH, Graziano ME, Khan MS, Dasgupta P, Ahmed K (2015) Validation of the GreenLight^TM Simulator and development of a training curriculum for photoselective vaporisation of the prostate. BJU Int 115(6):994–1003. https://doi.org/10.1111/bju.12842CrossRefPubMed

34.

Kishore TA, Beddingfield R, Holden T, Shen Y, Reihsen T, Sweet RM (2009) Task deconstruction facilitates acquisition of transurethral resection of prostate skills on a virtual reality trainer. J Endourol 23(4):665–668. https://doi.org/10.1089/end.2008.0531CrossRefPubMed

35.

Sweet R, Konchada V, Jain S, Zhang N, Zhou X, Burke D, Wong C, Carson C, Roehrborn C, Shen Y (2011) 1487 training laser prostate surgery with an advanced simulation based curriculum: the Victor^® greenlight trainer. J Urol 185(4S):e596. https://doi.org/10.1016/j.juro.2011.02.1445CrossRef

36.

Shamim Khan M, Ahmed K, Gavazzi A, Gohil R, Thomas L, Poulsen J, Ahmed M, Jaye P, Dasgupta P (2013) Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int 111(3):518–523. https://doi.org/10.1111/j.1464-410X.2012.11204.xCrossRefPubMed

37.

Noureldin YA, Elkoushy MA, Aloosh M, Carrier S, Elhilali MM, Andonian S (2016) Objective structured assessment of technical skills for the photoselective vaporization of the prostate procedure: a pilot study. J Endourol 30(8):923–929. https://doi.org/10.1089/end.2016.0270CrossRefPubMed

38.

Kailavasan M, Berridge C, Athanasiadis G, Gkentzis A, Rai B, Jain S, Biyani CS, Nabi G (2020) Design, implementation, and evaluation of a novel curriculum to teach transurethral resection of the prostate (TURP): a 3-year experience of urology simulation bootcamp course. World J Urol. https://doi.org/10.1007/s00345-020-03104-3CrossRefPubMed

39.

Biyani CS, Hanchanale V, Rajpal S, Jain S, Garthwaite M, Cartledge J, Somani B, Cornford P, Gowda B, Koenig P, Reeves F, Rogawski K, Myatt A, Eardley I, Terry T (2017) First urology simulation boot camp in the United Kingdom. Afr J Urol 23(3):258–267. https://doi.org/10.1016/j.afju.2017.03.002CrossRef

40.

Kailavasan M, Hanchanale V, Rajpal S, Morley R, McLlhenny C, Somani B, Nabi G, Gowda R, Jain S, Biyani CS, Myatt A (2019) A method to evaluate trainee progression during simulation training at the urology simulation boot camp (USBC) course. J Surg Educ 76(1):215–222. https://doi.org/10.1016/j.jsurg.2018.06.020CrossRefPubMed

41.

Somani BK, Van Cleynenbreugel B, Gozen A, Palou J, Barmoshe S, Biyani S, Gaya JM, Hellawell G, Pini G, Oscar FR, Sanchez Salas R, Macek P, Skolarikos A, Wagner C, Eret V, Haensel S, Siena G, Schmidt M, Klitsch M, Vesely S, Ploumidis A, Proietti S, Kamphuis G, Tokas T, Geraghty R, Veneziano D (2019) The European Urology Residents Education Programme Hands-on Training Format: 4 years of hands-on training improvements from the European School of Urology. Eur Urol Focus 5(6):1152–1156. https://doi.org/10.1016/j.euf.2018.03.002CrossRefPubMed

42.

Young M, Kailavasan M, Taylor J, Cornford P, Colquhoun A, Rochester M, Hanchanale V, Somani B, Nabi G, Garthwaite M, Gowda R, Reeves F, Rai B, Doherty R, Gkentzis A, Athanasiadis G, Patterson J, Wilkinson B, Myatt A, Biyani CS, Jain S (2019) The success and evolution of a urological “Boot Camp” for newly appointed UK urology registrars: incorporating simulation, nontechnical skills and assessment. J Surg Educ 76(5):1425–1432. https://doi.org/10.1016/j.jsurg.2019.04.005CrossRefPubMed

Title: Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology
Authors: Theodoros Tokas
Gernot Ortner
Angelis Peteinaris
Bhaskar Kumar Somani
Thomas Herrmann
Udo Nagele
Domenico Veneziano
Ali Serdar Gözen
Panagiotis Kallidonis
Publication date: 01-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Transurethral Prostate Resection
Laser
Published in: World Journal of Urology / Issue 5/2022
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-021-03886-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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