Simulation-Based Training Models for Urolithiasis: A Systematic Review

Role of simulation in kidney stone disease: A systematic review of literature trends in the 26 years

BACKGROUND

Minimally invasive techniques for treatment of urinary stones requires expertise, experience and endoscopic skills. Simulators provide a low-stress and low-risk environment while providing a realistic set-up and training opportunities.

AIM

To report the publication trend of 'simulation in urolithiasis' over the last 26 years.

METHODS

Research of all published papers on "Simulation in Urolithiasis" was performed through PubMed database over the last 26 years, from January 1997 to December 2022. Papers were labelled and divided in three subgroups: (1) Training papers; (2) Clinical simulation application or surgical procedures; and (3) Diagnostic radiology simulation. Each subgroup was then divided into two 13-year time periods to compare and identify the contrast of different decades: period-1 (1997-2009) and period-2 (2010-2022).

RESULTS

A total of 168 articles published on the application of simulation in urolithiasis over the last 26 years (training: n = 94, surgical procedures: n = 66, and radiology: n = 8). The overall number of papers published in simulation in urolithiasis was 35 in Period-1 and 129 in Period-2, an increase of +269% (P = 0.0002). Each subgroup shows a growing trend of publications from Period-1 to Period-2: training papers +279% (P = 0.001), surgical simulations +264% (P = 0.0180) and radiological simulations +200% (P = 0.2105).

CONCLUSION

In the last decades there has been a step up of papers regarding training protocols with the aid of various simulation devices, with simulators now a part of training programs. With the development of 3D-printed and high-fidelity models, simulation for surgical procedure planning and patients counseling is also a growing field and this trend will continue to rise in the next few years.

Use of Thiel-embalmed cadavers in urology training and their ability to retain real-life anatomy: a systematic review

BACKGROUND

Thiel-embalmed cadavers (TeCs) have been proposed as an alternative and probably safer method of surgical training, compared to formalin-embalmed cadavers. We aimed to perform a systematic review on the use of TeCs in urology training and their ability to represent real-life anatomy.

METHODS

PubMed, SCOPUS and Cochrane databases were searched for articles with purpose to explore the use of TeCs in urology training, without date restrictions, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From each paper, we evaluated the type of procedure, the number of participants, the type of study, the educational outcomes and their level, according to Kirkpatrick hierarchy.

RESULTS

Of the 225 records initially retrieved, eight articles were eventually included. All studies evaluated participants' perceptions about the procedure. Overall, urology trainees and specialists have positively commented on the educational value of TeCs, which have been also found able to adequately mimic real-life conditions. In all the eight studies, trainees stated that tissue quality of TeCs was adequately realistic and considered TeCs as a useful surgical training tool.

CONCLUSION

Although the use of TeCs in urology training has so far been limited, their value as a surgical training tool has been positively perceived. These outcomes suggest that TeCs may also enhance urology trainees' surgical skills and may encourage their implementation as a simulation tool in urology training.

The design and validation of a low-cost trans perineal (TP) prostate biopsy simulator for training: improving trainees' confidence and cognitive targeting skills

PURPOSE

The aim of this research was to create a novel and low-cost TP prostate biopsy simulator that has face, content and construct validity with high educational value.

METHODS

This research developed a trans perineal prostate (TP) biopsy simulator using 3D-printed moulds and tissue-mimicking materials. Important regions (anterior, mid, and posterior zones) were coded with different colours. Ultrasound visible abnormal lesions were embedded in the prostate phantom. Expert and novice participants in TP biopsies were recruited. Essential skills were identified through the consensus of six experts. These skills were assessed through tasks performed by participants. This included the accuracy and timing of systematic and target biopsies. Immediate feedback was determined by the colour of the biopsy cores taken. A survey was distributed to evaluate its realism and educational value.

RESULTS

The material cost of one simulator was £7.50. This simulator was proven to have face, content, and construct validity. There was a significant difference (p = 0.02) in the accuracy of systematic biopsies between both experts and novices. Significant difference was also observed (p = 0.01), in accurately identifying target lesion on ultrasound between both groups. Participants rated the overall realism of the simulator 4.57/5 (range 3-5). 100% of the experts agreed that introducing this simulator to training will be beneficial. 85.7% of the participants strongly agree that the simulator improved their confidence in TP biopsies.

CONCLUSION

There is value in integrating this proof-of-concept TP prostate biopsy simulator into training. It has highly rated educational value and has face, content, and construct validity.

[Impact of simulation-based training in endourology: A systematic review of the literature]

INTRODUCTION

The impact of simulation on the acquisition of surgical skills as well as their transfer to the operating room is still debated. The objective was to assess these two specific points, focusing on the field of endourology.

METHODS

A systematic review of the literature, following the PRIMA statement, was performed using Medline database through September 2021 without time limit. Studies focusing on the impact of simulators on the acquisition of surgical technical skills as well as their transfer to the operating room in the field of endourology were included. The endourological procedures were: cystoscopy, ureteroscopy, percutaneous nephrolithotomy, endoscopic treatment of benign prostatic hyperplasia, endoscopic bladder resection.

RESULTS

Among the 11,442 publications identified, fifty-two studies were included in the analysis. The majority reported an improvement in procedure time of the requested tasks and dexterity of participants, regardless of the type of simulator and procedure. The level of evidence of included studies was often low. Few studies evaluated the transfer of acquired skills from the simulator to the operating room.

CONCLUSION

This review showed the positive impact of simulation on the acquisition of technical skills in endourology. However, in order to include proficiency-based progression in the curriculum of trainees, some parameters such as the choice of reference simulators, choice of tasks, and method of validation of acquired skills must be validated in a consensual manner to offer a quality training.

A Systematic Review of Simulation-Based Training in Vascular Surgery

Introduction

Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula.

Methods

PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick’s modern concept of validity alongside an LoE score according to McGaghie’s translational outcomes.

Results

Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5.

Conclusions

Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed.

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

Objective

Different 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.

Methods

This 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.

Results

Participants 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.

Conclusion

The 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.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-021-03604-w.