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Llorente-Ortega M, Polo R, Chiva S, Martín-Calvo N, Sáenz-Santa-María E, Diez-Caballero F, Fernandez S. The development and validation of a new simulator for endourology. Actas Urol Esp 2023; 47:236-243. [PMID: 36731822 DOI: 10.1016/j.acuroe.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. MATERIALS AND METHODS A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. RESULTS New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (p<0.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation ±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. CONCLUSION The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.
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Affiliation(s)
- M Llorente-Ortega
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - R Polo
- Faculty of Medicine, Universidad de Navarra, Pamplona, Spain
| | - S Chiva
- Department of Urology, Clínica Universidad de Navarra, Pamplona, Spain
| | - N Martín-Calvo
- Faculty of Medicine, Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain, CIBER-obn, Instituto Salud Carlos III, IdiSNA, Institute of Health Research of Navarra, Madrid, Spain
| | - E Sáenz-Santa-María
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - F Diez-Caballero
- Department of Urology, Clínica Universidad de Navarra, Pamplona, Spain
| | - S Fernandez
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain.
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Llorente-Ortega M, Polo R, Chiva S, Martín-Calvo N, Sáenz-Santa-María E, Diez-Caballero F, Fernández S. Desarrollo y validación de un nuevo simulador para endourología. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ritchie A, Pacilli M, Nataraja RM. Simulation-based education in urology - an update. Ther Adv Urol 2023; 15:17562872231189924. [PMID: 37577030 PMCID: PMC10413896 DOI: 10.1177/17562872231189924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.
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Affiliation(s)
- Angus Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, Melbourne, Australia
| | - Ramesh M. Nataraja
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne 3168, Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia
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Borque-Fernando Á, Redondo-Redondo C, Orna-Montesinos C, Esteban LM, Denizón-Arranz S, Tejero-Sánchez A, García-Ruiz R, Sanchez-Zalabardo JM, Gracia-Romero J, Monreal-Híjar A, Gil-Sanz MJ, Sanz G, Sanz-Pozo M, Romero-Fernández F. Teaching Urology to Undergraduates: A Prospective Survey of What General Practitioners Need to Know. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111687. [PMID: 34770201 PMCID: PMC8583650 DOI: 10.3390/ijerph182111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
Background: Higher education training in Medicine has considerably evolved in recent years. One of its main goals has been to ensure the training of students as future adequately qualified general practitioners (GPs). Tools need to be developed to evaluate and improve the teaching of Urology at the undergraduate level. Our objective is to identify the knowledge and skills needed in Urology for the real clinical practice of GPs. Methods: An anonymous self-administered survey was carried out among GPs of Primary Care and Emergencies which sought to evaluate urological knowledge and necessary urological skills. The results of the survey were exported and descriptive statistics were performed using IBM SPSS Statistics version 19.0. Results and limitations: A total of 127 answers were obtained, in which ‘Urological infections’, ‘Renal colic’, ‘PSA levels and screening for prostate cancer’, ‘Benign prostatic hyperplasia’, ‘Hematuria’, ‘Scrotal pain’, ‘Prostate cancer diagnosis’, ‘Bladder cancer diagnosis’, ‘Urinary incontinence’, and ‘Erectile dysfunction’ were rated as Very high or High formative requirements (>75%). Regarding urological skills, ‘Abdominal examination’, ‘Interpretation of urinalysis’, ‘Digital rectal examination’, ‘Genital examination’, and ‘Transurethral catheterization’ were assessed as needing Very high or High training in more than 80% of the surveys. The relevance of urological pathology in clinical practice was viewed as Very high or High in more than 80% of the responses. Conclusions: This study has shown helpful results to establish a differentiated prioritization of urological knowledge and skills in Primary Care and Emergencies. Efforts should be aimed at optimizing the teaching in Urology within the Degree of Medicine which consistently ensures patients’ proper care by future GPs.
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Affiliation(s)
- Ángel Borque-Fernando
- Department of Surgery, Gynaecology and Obstetrics, Urology Area, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; (C.R.-R.); (J.G.-R.); (M.J.G.-S.); (F.R.-F.)
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain; (A.T.-S.); (R.G.-R.); (J.M.S.-Z.); (M.S.-P.)
- Correspondence: (Á.B.-F.); (L.M.E.)
| | - Cristina Redondo-Redondo
- Department of Surgery, Gynaecology and Obstetrics, Urology Area, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; (C.R.-R.); (J.G.-R.); (M.J.G.-S.); (F.R.-F.)
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain; (A.T.-S.); (R.G.-R.); (J.M.S.-Z.); (M.S.-P.)
| | - Concepción Orna-Montesinos
- Department of English and German Philology, School of Education, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Luis Mariano Esteban
- Department of Applied Mathematics Engineering, School of la Almunia, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: (Á.B.-F.); (L.M.E.)
| | | | - Arlanza Tejero-Sánchez
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain; (A.T.-S.); (R.G.-R.); (J.M.S.-Z.); (M.S.-P.)
| | - Ramiro García-Ruiz
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain; (A.T.-S.); (R.G.-R.); (J.M.S.-Z.); (M.S.-P.)
| | | | - Jesús Gracia-Romero
- Department of Surgery, Gynaecology and Obstetrics, Urology Area, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; (C.R.-R.); (J.G.-R.); (M.J.G.-S.); (F.R.-F.)
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain; (A.T.-S.); (R.G.-R.); (J.M.S.-Z.); (M.S.-P.)
| | - Antonio Monreal-Híjar
- Department of Medicine, Psychiatry and Dermatology, Medicine Area, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain;
| | - María Jesús Gil-Sanz
- Department of Surgery, Gynaecology and Obstetrics, Urology Area, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; (C.R.-R.); (J.G.-R.); (M.J.G.-S.); (F.R.-F.)
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain; (A.T.-S.); (R.G.-R.); (J.M.S.-Z.); (M.S.-P.)
| | - Gerardo Sanz
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems-BIFI University of Zaragoza, 50009 Zaragoza, Spain;
| | - Mónica Sanz-Pozo
- Instituto de Investigación Sanitaria Aragón, 50009 Zaragoza, Spain; (A.T.-S.); (R.G.-R.); (J.M.S.-Z.); (M.S.-P.)
| | - Francisco Romero-Fernández
- Department of Surgery, Gynaecology and Obstetrics, Urology Area, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; (C.R.-R.); (J.G.-R.); (M.J.G.-S.); (F.R.-F.)
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García-Perdomo HA, Echeverría-García F, Gutiérrez Rojas AF. El rol de la simulación en la practica y entrenamiento urológico. Rev Urol 2021. [DOI: 10.1055/s-0041-1736204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Herney Andrés García-Perdomo
- Departamento de Cirugía/Urología. Grupo de Investigación UROGIV. Escuela de Medicina. Universidad del Valle. Cali, Colombia
| | - Fernando Echeverría-García
- Departamento de Cirugía/Urología. Grupo de Investigación UROGIV. Escuela de Medicina. Universidad del Valle. Cali, Colombia
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Aydın A, Griffin CM, Brunckhorst O, Al-Jabir A, Raison N, Aya H, McIlhenny C, Brewin J, Shabbir M, Palou Redorta J, Khan MS, Dasgupta P, Ahmed K. Non-technical skills for urological surgeons (NoTSUS): development and evaluation of curriculum and assessment scale. World J Urol 2020; 39:2231-2237. [PMID: 32809178 PMCID: PMC8217036 DOI: 10.1007/s00345-020-03406-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022] Open
Abstract
Objective In the last decade non-technical skills (NTS) have emerged as a vital area for improvement within surgery. This study aims to develop and evaluate a Non-technical Skills for Urological Surgeons (NoTSUS) training curriculum and assessment scale. Methods This international, longitudinal and observational study began with a 3-round Delphi methodology to refine curriculum contents and rating scale. Sessions with up to four participants were delivered where each candidate undertook an independent scenario within the validated full immersion simulation environment. Candidates were assessed using both the NoTSS (Non-technical Skills for Surgeons) and NoTSUS rating scales by NTS-trained and non-trained experts. A post-training evaluation survey was distributed. Results 62 participants comprising trainees (n = 43) and specialists (n = 19) undertook the NoTSUS course. The NoTSS and NoTSUS scales correlated well, with a mean difference of 3.3 in the overall total (p = 0.10, r = 0.53). However, there was significant differences in scores between the NoTSS-trained and non-trained raters (n = 28, p = 0.03). A one-way ANOVA test revealed significant improvement throughout the four simulation scenarios in each session (p = 0.02). The NoTSUS curriculum received positive feedback from participants and demonstrated educational value and acceptability. Conclusions The NoTSUS curriculum has demonstrated high educational value for NTS training aimed at urologists, with marked improvement throughout sessions. Correlation of NoTSUS and NoTSS scales proves its suitability for evaluating NTS in future training. Demonstration of inter-rater reliability indicates that the scale is reliable for use in assessment by expert faculty members. Furthermore, qualitative feedback from participants suggests gain of transferrable skills over the course. Electronic supplementary material The online version of this article (10.1007/s00345-020-03406-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdullatif Aydın
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK.
| | - Cora M Griffin
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Ahmed Al-Jabir
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Haleema Aya
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | | | - James Brewin
- Department of Urology, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Majid Shabbir
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Joan Palou Redorta
- European School of Urology, European Association of Urology, Amsterdam, The Netherlands
- Dept. of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
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Takashima Y, Handler SJ, Zeno A, Miyazaki B, Del Canto I, Yazdany T, Le TH. Use of pelvic model-based simulation for sacrospinous ligament fixation education in novice learners: a single-blinded randomized controlled trial. Int Urogynecol J 2020; 32:897-903. [PMID: 32696185 DOI: 10.1007/s00192-020-04445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/09/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesize that there will be improvement in a novice learners' confidence and skill level with sacrospinous ligament fixation (SSLF) following a pelvic model-based simulation. METHODS We performed a single-blinded randomized controlled trial with obstetrics and gynecology residents who were novices at SSLF. The residents were randomly assigned to two groups. The control group received a lecture on the SSLF procedure and anatomy, whereas the intervention group received the same lecture in addition to a pelvic model-based simulation session taught by urogynecologists. The residents' knowledge of SSLF anatomy and confidence level with the procedure were measured via assessments administered before and after the educational interventions. Their technical skills were objectively assessed by one of two fellowship-trained urogynecologists who were blinded to their group allocation. RESULTS A total of 28 residents were recruited with 14 residents in each group and equal distribution of junior and senior trainees. None of the residents had previously performed the SSLF procedure. There was no difference in anatomical knowledge between the two groups. The intervention group showed a greater increase in their average confidence score compared with the control group: 4.0 ± 1.4 (95% CI 3.1-4.8) versus 2.6 ± 1.6 (95% CI 1.7-3.4) respectively, with p = 0.02. The intervention group also showed better objective scores in specific technical skills, such as instrument handling (p < 0.001), instrument movement/motion (p < 0.001), and speed (p = 0.01). CONCLUSION Our results demonstrate that inclusion of a pelvic model simulation significantly improves confidence and certain technical skills of novice trainees in performing SSLF.
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Affiliation(s)
- Yoko Takashima
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA.
| | - Stephanie J Handler
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA
| | - Aldene Zeno
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Keck Hospital of USC, Los Angeles, CA, USA
| | - Brian Miyazaki
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Tajnoos Yazdany
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA
| | - Tam Hoang Le
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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Nonde J, Laher AE, McDowall J, Adam A. A Systematic Review of the World of Validated Suprapubic Catheter Insertion Simulation Trainers: From 'Head-Blocks' to 'Lunch Boxes'. Curr Urol 2020; 13:179-188. [PMID: 31998050 PMCID: PMC6977004 DOI: 10.1159/000499273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/14/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Various suprapubic catheter insertion simulators have been described to aid in the training of this fundamental skill. The purpose of this review was to evaluate and critically appraise all validated simulators. METHODS The PubMed, Web of Science, Cochrane Library, Scopus, British Medical Journal and the Embase databases were searched (March 2018), by using key search terms "suprapubic trainer", "suprapubic model", "suprapubic simulation" and "suprapubic simulator". RESULTS A total of 196 articles were identified; 117 unrelated, 53 animal studies and 20 duplications. Only 6 articles met the inclusion criteria for this review. The median number of participants per study was 30.5. Material costs ranged from 1.71 to 60 dollars per model. Only 2 studies incorporated the use of ultrasound. CONCLUSION Despite validated suprapubic catheter insertion models being a specially needed learning resource, only few have been described-mostly for not resourceful environments. There exists a general lack of guidelines on model validation processes. There is a need to develop, appropriately validate and integrate models into training curriculum.
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Affiliation(s)
- James Nonde
- Division of Emergency Medicine, Faculty of Health Sciences
| | | | - Jared McDowall
- Division of Emergency Medicine, Faculty of Health Sciences
| | - Ahmed Adam
- Division of Urology, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Smith B, Dasgupta P. 3D printing technology and its role in urological training. World J Urol 2019; 38:2385-2391. [PMID: 31676911 DOI: 10.1007/s00345-019-02995-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/20/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Surgical simulation and 3D printing have both been gaining traction exclusively over the past decade, and now have started to appear simultaneously in current research. The opinion that surgical simulation should be part of surgery curricula is becoming ever more apparent. In this review, we highlight and briefly examine the 3D printing workflow, and each facet of the current body of literature using this technology in the augmentation of surgical training, in addition to the challenges currently faced. METHODS A broad literature search was conducted pertaining to the utilisation of 3D printing in urology, aiming to sample the majority of use-cases of this fairly novel technology. The 3D printing workflow, current use-cases of 3D printing as applied to urological training, and challenges faced have been described. RESULTS A respectable number of surgical use-cases utilising 3D printing technology in their development were identified, including but not limited to percutaneous nephrolithotomy, partial nephrectomy, renal transplantation, laparoscopic pyeloplasty, prostate brachytherapy, transurethral resection of bladder tumours, urethrovesical anastomosis simulation devices, in addition to laparoscopic trainers and robotic surgery phantoms. CONCLUSION Over the last decade, urology has taken this cutting-edge technology in its stride; flaunting its efficacy in the augmentation of a number of procedural training applications. The number of use cases for this technology is only expected to rise as its virtues are demonstrated, the ease of use and availability of 3D printing units advances, and costs abated.
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Affiliation(s)
- Brandon Smith
- King's College London, MRC Centre for Transplantation, London, UK
| | - Prokar Dasgupta
- King's College London, MRC Centre for Transplantation, London, UK.
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Non-technical skills: a review of training and evaluation in urology. World J Urol 2019; 38:1653-1661. [PMID: 31529246 PMCID: PMC7303051 DOI: 10.1007/s00345-019-02920-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE With non-technical skills (NTS) deficits being recognised as a major cause for error in surgery, there is an increasing interest in their training and evaluation. A growing number of training courses are emerging and some NTS curricula have also been created. Many different training methods are described in the literature but there is still uncertainty with regards to their optimum combination within a curriculum. METHODS A literature review of the electronic database Medline was performed. All articles published before December 2018 were screened by abstract and included if deemed relevant by the author. The included articles' reference lists were also screened for further relevant studies. RESULTS Simulation training is accepted as the most effective way to train NTS. Within simulation training, it is shown that the 'igloo' full immersion/distributed simulation environment is appropriate for teaching NTS in urological scenarios where a designated operating room or space is not available. The use of multiple settings, for example wards and clinics as well as the operating room, is advantageous, as is training in an interprofessional team. Classroom teaching also plays a role in NTS training as an adjunct to simulation, with evidence that it improves some parameters of NTS. All levels, including qualified surgeons, benefit from NTS training; however, adaptation to both trainee level and specialty is important. Although less time consuming, training juniors and seniors together mainly benefits juniors, and training NTS at the same time as technical skills detracts from the quality of teaching. Debriefing is an important part of training and should be well structured; there are many debriefing models in existence, allowing for choice of method based on examiner preference and participant demographic. Furthermore, examiners should be well briefed in their task and trained in NTS assessment. CONCLUSION To move forward, studies should combine tried and tested learning techniques into a curriculum covering all training levels, which should then be validated and followed up long term to ensure a positive impact on patient safety.
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Ng SC, Ong WM. Training the registrar or the fellow? Time to choose? ANZ J Surg 2019; 89:802-803. [PMID: 31379077 DOI: 10.1111/ans.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Suat Chin Ng
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Boxhill Hospital, Melbourne, Victoria, Australia
| | - Wei Ming Ong
- Department of Colorectal Surgery, Boxhill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Urology resident training in laparoscopic surgery - results of the first national survey in Poland. Wideochir Inne Tech Maloinwazyjne 2019; 14:433-441. [PMID: 31534575 PMCID: PMC6748061 DOI: 10.5114/wiitm.2019.81439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction For many urological procedures the open approach is being replaced by the laparoscopic approach. Laparoscopy technique requires special training conditions. A well-designed, step-by step training program is significantly important for shortening the learning curve. Aim The purpose of the study was to evaluate urology residents’ (UR) experience in laparoscopic procedures, training patterns and facilities available in departments of urology in Poland. Material and methods The survey developed by the authors included 18 questions concerning laparoscopy training and was distributed among UR who participated in 2 courses in laparoscopic surgery for UR in Poland in 2017. The survey consisted of questions regarding the number of laparoscopic procedures, acquired laparoscopic experience, laparoscopic simulation training and motivation for further learning. Results Of the 2017 invited UR in Poland, 108 (34%) completed the survey. Seventy-two (78%) UR from the study group have access to laparoscopic surgery in their department. Only 20 (25%) of urology departments are equipped with a laparoscopy box and a small number of UR perform regular training. As a primary operator basic (varicocele repair) and advanced (e.g. radical nephrectomy, radical prostatectomy, nephron-sparing surgery) laparoscopic procedures are performed respectively by 55 (71%) UR and 8 (10%) UR. Most residents evaluated their laparoscopic skills as poor (15, 19%), very poor (31, 40%) or absent (10, 13%), while only 22 (28%) evaluated them as at least satisfactory. Conclusions Laparoscopic technique is available in most Polish training centers. However, the majority of UR consider their skills unsatisfactory. Additionally, a large number of Polish UR do not have access to intensive training. UR considered that their availability of training courses and fellowships is low. Surgical exposure among Polish UR comprises mainly minor laparoscopic procedures.
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Robinson AJ, Miller G, Rukin N. Simulation in urological training: Where are we in 2017? JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817722933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traditional Halstedian principles are no longer compatible with modern day urological training. Changing patterns of healthcare provision and the advanced nature of minimally invasive urological surgery have resulted in trainees receiving reduced exposure to independent operative experience. The drive towards consultant-delivered care, coupled with the introduction of the European working time directive, necessitate the urology trainee to meet end-of-training competencies with fewer learning opportunities compared with previous generations. Simulation provides an opportunity to compensate for reduced operative experience by augmenting both technical and non-technical skills development. A variety of simulation models can be used from cadaveric, synthetic and animal models to advanced virtual reality to aid surgical training. Whilst simulation is not without limitations, it has the potential to significantly enhance procedural competency and non-technical skills in a risk-free environment. Clear benefits, including equipment familiarity and trainee confidence have been demonstrated. However, direct transferability of these benefits to an operating-theatre is not clearly evident. Whilst not a substitute for clinical practice, simulation is likely to prove itself as a valuable adjunct to urological training. In this narrative review, we examine the current literature on simulation training in relation to urological surgery.
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Affiliation(s)
- Andrew J Robinson
- University Hospital of North Staffordshire NHS Trust, Royal Stoke University Hospital, UK
| | - George Miller
- King’s College London School of Medical Education, UK
| | - Nick Rukin
- Metro North Hospital and Health Service, Redcliffe Hospital, Queensland, Australia
- University of Queensland, Queensland, Australia
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Paige JT, Khamis NN, Cooper JB. Learning how to "teach one": A needs assessment of the state of faculty development within the Consortium of the American College of Surgeons Accredited Education Institutes. Surgery 2017; 162:1140-1147. [PMID: 28811044 DOI: 10.1016/j.surg.2017.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/13/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Developing faculty competencies in curriculum development, teaching, and assessment using simulation is critical for the success of the Consortium of the American College of Surgeons Accredited Education Institutes program. The state of and needs for faculty development in the Accredited Education Institute community are unknown currently. The Faculty Development Committee of the Consortium of the Accredited Education Institutes conducted a survey of Accredited Education Institutes to ascertain what types of practices are used currently, with what frequency, and what needs are perceived for further programs and courses to guide the plan of action for the Faculty Development Committee. METHODS The Faculty Development Committee created a 20-question survey with quantitative and qualitative items aimed at gathering data about practices of faculty development and needs within the Consortium of Accredited Education Institutes. The survey was sent to all 83 Accredited Education Institutes program leaders via Survey Monkey in January 2015 with 2 follow-up reminders. Quantitative data were compiled and analyzed using descriptive statistics, and qualitative data were interpreted for common themes. RESULTS Fifty-four out of the 83 programs (65%) responded to the survey. Two-thirds of the programs had from 1 to 30 faculty teaching at their Accredited Education Institutes. More than three-quarters of the programs taught general surgery, emergency medicine, or obstetrics/gynecology. More than 60% of programs had some form of faculty development, but 91% reported a need to expand their offerings for faculty development with "extreme value" for debriefing skills (70%), assessment (47%), feedback (40%), and curriculum development (40%). Accredited Education Institutes felt that the Consortium could assist with faculty development through such activities as the provision of online resources, sharing of best practices, provision of a blueprint for development of a faculty curriculum and information related to available, credible master programs of faculty development and health professions education. CONCLUSION Many Accredited Education Institutes programs are engaged in faculty development activities, but almost all see great needs in faculty development related to debriefing, assessment, and curricular development. These results should help to guide the action and decision-making of the Consortium Faculty Development Committee to improve teaching within the American College of Surgeons Accredited Education Institutes.
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Affiliation(s)
- John T Paige
- Department of Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA.
| | - Nehal N Khamis
- Medical Education Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; Pathology and Medical Education Departments, College of Medicine, Suez Canal University, Ismailia, Egypt
| | - Jeffrey B Cooper
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School and the Center for Medical Simulation, Boston, MA
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Kailavasan M, Abdul-Rahman A, Hanchanale V, Rajpal S, Rogawski K, Palit V, Myatt A, Jain S, Biyani CS. The Validation of the Clinical Male Pelvic Trainer Mk 2-Advanced Models for Scrotal Examination Simulation. JOURNAL OF SURGICAL EDUCATION 2017; 74:423-430. [PMID: 27825660 DOI: 10.1016/j.jsurg.2016.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/24/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To validate the use of a novel physical model, the "Clinical Male Pelvic Trainer (CMPT) Mk 2-Advanced," for scrotal examination simulation and evaluate its use for surgical education. MATERIALS AND METHODS A total of 7 CMPT Mk 2-Advanced scrotal models were used for teaching: normal, varicocele, testicular tumor, epididymal cyst, hydrocele, epididymo-orchitis, and indirect inguinoscrotal hernia. At 4 surgical courses in the West Yorkshire Foundation Deanery, UK, between 2015 and 2016, trainees were asked to assess their clinical experience, confidence levels in diagnosing scrotal pathology and simulation properties of the scrotal models on a 5-point Likert Scale. Expert responses were used to validate these findings. RESULTS In total, 65 trainees and 12 experts (including 3 senior residents) participated in the study (n = 77). There was a positive-tailed distribution in responses from experts for realistic simulation of scrotal contents and pathology; only 1.5% and 14.4% of all responses by experts were scored as a "1" (strongly disagree) or "2" (disagree). The intraclass coefficient (κ) was 0.86 among experts. No significant differences between experts and trainees in assessment of simulation were observed. Following use of the models, there was a significant increase in confidence scores matched by trainee (p < 0.001). Approximately 92.9% and 100% of trainees and experts were in favor of using the models for assessment and future training respectively. CONCLUSIONS Our study demonstrates that the CMPT MK 2-Advanced models have high "face validity" and may be a valuable tool for surgical education. The use of these models should be explored for use in the curriculum at medical school.
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Affiliation(s)
- Mithun Kailavasan
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - Ahmad Abdul-Rahman
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - Vishwanath Hanchanale
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Sanjay Rajpal
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Karol Rogawski
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Victor Palit
- North Tees and Hartlepool NHS Trust, Stockton-on-Tees, United Kingdom
| | - Andy Myatt
- Hull & East Yorkshire NHS Trust, Hull, United Kingdom
| | - Sunjay Jain
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
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Zhao Z, Niu P, Ji X, Sweet RM. State of Simulation in Healthcare Education: An Initial Survey in Beijing. JSLS 2017; 21:JSLS.2016.00090. [PMID: 28144123 PMCID: PMC5266512 DOI: 10.4293/jsls.2016.00090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background and Objectives: In 2013, medical error was the third leading cause of death in the United States.1 In China, as in the case with the United States, training and assessment are developing as a strategy to reduce the occurrence of such errors. The objective of this study was to assess the current state of the use of simulation-based training in Beijing and to explore the barriers to further development. Methods: This study included hospitals in Beijing accredited by the Standardized Residency Training (SRT) program. The questionnaire was designed online and distributed to the SRT management departments by e-mail or instant message. Results: Thirty hospitals were invited to participate in this survey, and 15 responses were completed and met the inclusion criteria. Task trainers (15/15), full-scale mannequins (14/15), standardized patients (12/15), and virtual reality workstations (11/15) were the most common types of simulation modalities available for use. Among the given specialties for SRT, the availability of simulation courses was 2/2 for pediatric internal medicine, 1/1 for pediatric surgery, 10/11 for surgery, 11/14 for internal medicine, 7/9 for anesthesiology, 6/8 for emergency medicine, and 3/9 for obstetrics/gynecology. Of the 13 institutions with available simulation curricula, 12/13 had simulation focused on proficiency-based skill training, 11/13 had medical knowledge learning, 10/13 had skill competency assessment. The main targeted trainees in these hospitals were residents (or postgraduate residents) and medical students (or interns). The top 2 barriers were the shortage of sustainable financial resources (12/15) and advocacy from their institutional authorities (7/15). Conclusion: It is evident that there is a need for more development of training facilities, and for training the “trainers” and administrators. Financial funding, curricular design, and research seem to be crucial for building a long-term, sustainable, effective program.
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Affiliation(s)
- Zichen Zhao
- WWAMI Institute for Simulation in Healthcare (WISH), University of Washington, Seattle, Washington, USA
| | - Pengfei Niu
- Department of General Surgery, Peking University Shougang Hospital, Beijing, China
| | - Xiang Ji
- Urology Department, Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
| | - Robert M Sweet
- WWAMI Institute for Simulation in Healthcare (WISH), University of Washington, Seattle, Washington, USA
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Colaco HB, Hughes K, Pearse E, Arnander M, Tennent D. Construct Validity, Assessment of the Learning Curve, and Experience of Using a Low-Cost Arthroscopic Surgical Simulator. JOURNAL OF SURGICAL EDUCATION 2017; 74:47-54. [PMID: 27720405 DOI: 10.1016/j.jsurg.2016.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/16/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We have developed a low-cost, portable shoulder simulator designed to train basic arthroscopic skills. This study aimed to establish the construct validity of the simulator by determining which parameters discriminated between experience levels and to assess the experience of using the simulator. DESIGN Participants were given an introductory presentation and an untimed practice run of a 6-step triangulation task using hooks and rubber bands. A total of 6 consecutive attempts at the task were timed, and the number of times the participant looked at their hands during the task was recorded. Participants then completed a questionnaire on their experience of using the simulator. SETTING St George's Hospital, London and the South West London Elective Orthopaedic Centre, Surrey. PARTICIPANTS Medical students, trainee doctors and surgeons, and consultant surgeons were approached to use the simulator. Participation was voluntary and nonincentivized. In total, 7 orthopedic consultants, 12 trainee doctors (ranging from foundation year 1 to clinical fellow post-Certificate of Completion of Training), and 9 medical students were recruited. RESULTS The average time for medical students to complete the task was 161 seconds, compared to 118 seconds for trainees, and 84 seconds for consultants. The average fastest time for medical students was 105 seconds, 73 seconds for trainees, and 52 seconds for consultants. Students were significantly slower than trainees (p = 0.026) and consultants (p = 0.001). However, times did not differ significantly between trainees and consultants. Consultants looked at their hands 0.7 times on average during the task compared with 2.8 and 3.4 times for trainees and students, respectively. More than 95% of participants found the exercise interesting and agreed or strongly agreed that the simulator was easy to use, easily portable, and well designed and constructed. DISCUSSION This study has established construct validity of the simulator by demonstrating the ability to distinguish between surgical experience levels. The learning curve shows improvement in individuals with or without arthroscopic or surgical experience. Simulation is becoming increasingly important in the training of medical students and surgical trainees; this study has established that low-cost portable arthroscopic box trainers may play a significant role.
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Affiliation(s)
- Henry B Colaco
- St George's University of London, London, United Kingdom
| | - Katie Hughes
- St George's University of London, London, United Kingdom.
| | - Eyiyemi Pearse
- St George's University of London, London, United Kingdom
| | | | - Duncan Tennent
- St George's University of London, London, United Kingdom
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Escolino M, Turrà F, Settimi A, Esposito C. Training for MIS in pediatric urology: proposition of a structured training curriculum. Transl Pediatr 2016; 5:315-323. [PMID: 27867857 PMCID: PMC5107368 DOI: 10.21037/tp.2016.09.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In Europe there are a lot of training centers for minimally invasive surgery (MIS) but a standardized MIS training program in pediatric urology doesn't exist at the moment. We performed a literature review with the last goals to propose a structured training curriculum in MIS urology for pediatric surgeons. Pediatric urologists have to obtain a valid MIS training curriculum completing the following 4 steps: (I) Theoretical part (theoretical courses, masterclass) to acquire theoretical knowledge; (II) experimental training (simulation on pelvic trainer, virtual reality simulators, animal models, 3-D ex-vivo models) to acquire basic laparoscopic skills; (III) stages in European centers of reference for pediatric MIS urology to learn all surgery aspects; (IV) personal operative experience. At the end of the training period, the trainee would be expected to perform several MIS urological procedures independently, under supervision of an expert tutor. At the end of the training program, each center will analyze the candidate training booklet and release for each applicant a certification after an exam. We think that this MIS training program in pediatric urology may assure an integrated acquisition of basic and advanced laparoscopic skills during residency training in pediatric urology. Each European country should adopt this program so as to secure a standardized technical qualification in MIS urology for all future pediatric urologists.
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Affiliation(s)
- Maria Escolino
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Francesco Turrà
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
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Vlok J, Zargar H. Editorial Comment: Two-Part Silicone Mold. A New Tool For Flexible Ureteroscopy Surgical Training. Int Braz J Urol 2016; 42:852. [PMID: 27564303 PMCID: PMC5006788 DOI: 10.1590/s1677-5538.ibju.2014.0638.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Homayoun Zargar
- Royal Melbourne Hospital, Melbourne, VIC, Australia.,Australian Prostate Cancer Research Centre, Melbourne, VIC, Australia
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Affiliation(s)
- Juan Gómez Rivas
- La Paz University Hospital, Department of Urology, Madrid, Spain
| | - Selçuk Sarıkaya
- Kecioren Research and Training Hospital, Department of Urology, Ankara, Turkey
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