Training for percutaneous renal access on a virtual reality simulator

Background The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC MentorTM is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training. Methods Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC MentorTM after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale （GRS） score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt. Results During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group （P=0.03 and 0.02, respectively）. Conclusions The training on the virtual reality simulator, PERC MentorTM, can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in teaching fluoroscopy-guided percutaneous renal access.

Effectiveness of the UroMentor virtual reality simulator in the skill acquisition of flexible cystoscopy

Background Virtual reality （VR） has been recognized as a useful modality in the training of surgical skills. With respect to basic endoscopic skill training of urology, we sought to investigate the effectiveness of the UroMentorTM virtual reality simulator （VRS） in the skill acquisition of flexible cystoscopy. Methods Urologists familiar with rigid cystoscopy procedures were selected to take part in a virtual training course of flexible cystoscopy. Changes in total operating time, frequency of injury, number of digital markers inside the bladder, and the global rating scale （GRS） scores were assessed following eight repeated training sessions on the UroMentorTM. Results Eighteen urologists voluntarily took part in the study. Total operating time was significantly lower after eight sessions of training by comparison （（111±10） seconds and （511±67） seconds, respectively; P〈0.001）. Additionally, the frequency of injury decreased with training from （12±2） times to （5±1） times （P〈0.001）, while the number of digital markers observed increased from 9±0 to 10±1 （P=0.005）. Finally, training with the UroMentor^TM resulted in a GRS increase from （1.3±0.2） points to （3.9±0.2） points （P〈0.001）. Conclusion the VRS UroMentorTM can improve urologists＇ ability to perform flexible cystoscopy and could be used as an effective trainina tool for trainees.