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.
ReznickRKMacraeH.Teaching surgical skills – changes in the wind. New Eng J Med2006; 355(25): 2664–2669.
2.
ChikweJSouzaACPepperJR.No time to train the surgeons. BMJ2004; 328(7437): 418–419.
3.
ShahJMackaySValeJet al. Simulation in urology – a role for virtual reality?BJU Int2001; 88(7): 661–665.
4.
GallagherAGTraynorO.Simulation in surgery; opportunity of threat?Ir J Med Sci2008; 177(4): 283–287.
5.
PreeceR. (2015) The current role of simulation in urological training. Cent Eur J Urol2015; 68(2): 207–211.
6.
LallasCD.Robotic VR simulation to measure competency: a step in the right direction. Can J Urol2016; 23(1): 8167.
7.
SommerKJ.Pilot training: what can surgeons learn from it?Arab J Urol2014; 12(1): 32–35.
8.
BrewinJAhmedKChallacombeB.An update and review of simulation in urological training. Int J Surg2014; 12(2): 103–108.
9.
GallagherAGRitterMEChampionHet al. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg2005; 24(2): 364–372.
10.
WhiteMADehaanAPStephensDDet al. Validation of a high fidelity adult ureteroscopy and renoscopy simulator. J Urol2010; 183(2): 673–677.
11.
BrehmerMSwartzR.Training on bench models improves dexterity in ureteroscopy. Eur Urol2005; 48(3): 458–463.
12.
ChouDSAbdelshehidCClaymanRVet al. Comparison of results of virtual-reality simulator and training model for basic ureteroscopy training. J Endourol2006; 20(4): 266–271.
13.
MatsumotoEDHamstraSJRadomskiSBet al. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol2002; 167(3): 1243–1247.
14.
SchoutBMAMuijtjenAMMHendrikAJMet al. Acquisition of flexible cystoscopy skills on a virtual reality simulator by experts and novices. BJU Int2010; 105(2): 234–239.
15.
SchoutBMAAnaniasHJKBemelmansBLHet al. Transfer of cysto-urethroscopy skills from a virtual-reality simulator to the operating room: a randomized controlled trial. BJU Int2010; 106(2): 226–231.
16.
SweetRPorterJOppenheimerPet al. Simulation of bleeding in endoscopic procedures using virtual reality. J Endourol2002; 16(7): 451–455.
17.
BrightEVineSWilsonMRet al. Face validity, construct validity and training benefits of a virtual reality TURP simulator. I J Surg2012; 10(3): 163–166.
18.
KallstromRHjertbergHSvanvikJ.Impact of virtual reality-simulated training on urology residents’ performance of transurethral resection of the prostate. J Endourol2010; 24(9): 1521–1528.
19.
AydinARaisonNKhanMSet al. Simulation based training and assessment in urological surgery. Nat Rev Urol2016; 13(9): 503–519.
20.
AydinAShafiAMKhanMSet al. Current status of simulation and training models in urological surgery: a systematic review. J Urol2016; 196(2): 312–320.
21.
MishraSKurienAPatelRet al. Validation of virtual reality simulation for percutaneous renal access training. J Endourol2010; 24(4): 635–640.
22.
LagunaMPArce-AlcazarAMochtarCAet al. Construct validity of the chicken model in the simulation of laparoscopic radical prostatectomy suture. J Endourol2006: 20(1); 69–73.
23.
TraxerOGettmanMTNapperCAet al. The impact of intense laparoscopic skills training on the operative performance of urology residents. J Urol2001; 166(5): 1658–1661.
24.
BrewinJNedasTChallacombeBet al. Face, content and construct validation of the first virtual reality laparoscopic nephrectomy simulator. BJU Int2010; 106(6): 850–854.
25.
MakiyamaKYamanakaHUenoDet al. Validation of a patient specific simulator for laparoscopic renal surgery. Int J Urol2015; 22(6): 572–576.
26.
HungAJZehnderPPatilMBet al. Face, content and construct validity of a novel robotic surgery simulator. J Urol2011; 186(3): 1019–1024.
27.
ChoJSHahnKYKwakJMet al. Virtual reality training improves da Vinci performance: a prospective trial. J Laparoendosc Adv Surg Tech A2013; 23(12): 992–998.
28.
YangKZhenHHubertNet al. From dV trainer to real robotic console: the limitations of robotic skill training. J Surg Educ Epub ahead of print 24April2017. DOI:10.1016/j.jsurg.2017.03.006.
29.
SchoutBMHendrikxAJScherphierAJet al. Update on training models in endourology: a qualitative systematic review of the literature between January 1980 and April 2008. Eur Urol2008; 54(6): 1247–1261.
30.
AhmedKJawadMAbboudiMet al. Effectiveness of procedural simulation in urology: a systemic review. J Urol2011; 186(1): 26–34.
31.
AbboudiHKhanMSAboumarzoukOet al. Current status of validation for robotic surgery simulators – a systemic review. BJU Int2013; 111(2): 194–205.
32.
GawandeAAZinnerMJStuddertDMet al. Analysis of errors reported by surgeons at three teaching hospitals. Surgery2003; 133(6): 614–621.
33.
PaigeJT.Surgical tea, training: promoting high reliability with nontechnical skills. Surg Clin North Am2010; 90(3): 569–581.
34.
LeeJYMucksavagePCanalesCet al. High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management. J Urol2012; 187 (4): 1385–1391.
35.
GettmannMTPereiraCWLipskyKet al. Use of high fidelity operating room simulation to assess and teach communication, teamwork and laparoscopic skills: initial experience. J Urol2009; 181(3): 1289–1296.
36.
VickersAJBiancoFJSerioAMet al. The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst2007; 99(15): 1171–1177.
37.
BuckleyCEKavanaghDOGallagherTKet al. Does aptitude influence the rate at which proficiency is achieved for laparoscopic appendectomy?J Am Coll Surg2013; 217(6): 1020–1027.
38.
KneeboneRLScottWDarziAet al. Simulation and clinical practice: strengthening the relationship. Med Educ2004; 38(10): 1095–102.
39.
McGaghieWCIssenbergSBPetrusaERet al. A critical review of simulation-based medical education research: 2003–2009. Med Educ2010; 44(1): 50–63.
40.
KhanSMAhmedKGavazziAet al. Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int2013; 111(3): 518–523.
