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Design and validation of a low-cost, high-fidelity model for robotic pyeloplasty simulation training

2020; Elsevier BV; Volume: 16; Issue: 3 Linguagem: Inglês

10.1016/j.jpurol.2020.02.003

1873-4898

Matthew D. Timberlake, Alaina Garbens, Bruce J. Schlomer, Nicholas Kavoussi, Adam J. Kern, Craig A. Peters, Jeffery Gahan,

Simulation-Based Education in Healthcare

Introduction/Background Owing to restrictions in operative experiences, urology residents can no longer solely rely on 'hands-on' operative time to master their surgical skills by the end of residency. Simulation training could help residents master basic surgical skills and steps of a procedure to maximize time in the operative room. However, simulators can be expensive or tedious to set up, limiting the availability to residents and training programs. Objective The authors sought to develop and validate an inexpensive, high-fidelity training model for robotic pyeloplasty. Study design Pyeloplasty models were created using Dragon Skin® FX-Pro tissue-mimicking silicone cast over 3-dimensional molds. Urology faculty and trainees completed a demographic questionnaire. The participants viewed a brief instructional video and then independently performed robotic dismembered pyeloplasty on the model. Acceptability and content validity were evaluated via post-task evaluation of the model. Construct validity was evaluated by comparing procedure completion time, the Global Evaluative Assessment of Robotic Skills (GEARS) score, blinded subjective physical evaluation of repair quality (1–10 scale), and flow rate between experts and novices. Results In total, 5 urology faculty, 6 fellows, and 14 residents participated. The median robotic console experience among faculty, fellows, and residents was 8 years (interquartile range [IQR] = 6–11), 3.5 years (IQR = 2–4 years), and 0 years (IQR = 0–0.5 years), respectively. The median procedure completion time was 29 min (IQR = 26–40 min), and the median flow rate was 1.11 mL/s (IQR = 0–1.34 mL/s). All faculty had flow rates >1.25 mL/s and procedure times <30 min compared with 2 of 6 fellows and none of the residents (P < 0.001). All faculty, half of the fellows, and none of the residents achieved a GEARS score ≥20, with a median resident score of 12.5 (IQR = 8–13) (P < 0.001). For repair quality, all faculty scored ≥9 (out of 10), all fellows scored ≥8, and the median score among residents was 6 (IQR = 2–6) (P < 0.001). The material cost was $1.32/model, and the average production time was 0.12 person-hours/model. Discussion and conclusion Graphical AbstractFigure showing completed pyeloplasty model mounted on the platform (left) and on the right, a participant completing a pyeloplasty using the model. View Large Image Figure Viewer Download Hi-res image