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Surgical Simulation in Pediatric Urologic Education

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Abstract

The drive to achieve improved patient outcomes and patient safety has led to innovation in surgical education. The century-old teaching paradigms of “see one, do one, teach one” and training by opportunity are inappropriate in a surgical world of rapidly introduced advanced technologies. The need for improved surgical education methods is no more critical than in pediatric surgery, where the complexity of patient diseases and the physical size of the patients tend to challenge the limitations of existing surgical technology and skill. Surgical simulation offers extraordinary opportunities to teach multiple clinical scenarios in a safe, nonhuman patient environment where performance feedback is immediate and objective. Although minimally invasive surgical techniques (laparoscopic and robotic) are ideally suited for computer-assisted or virtual reality training, medical decision-making simulation for minimally invasive surgery and open surgery is in its infancy and, arguably, the most important aspect of effective surgical practice.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Kohn L, JM C, Donaldson M, eds. To err is human: Building a safer heath care system. Washington, DC: National Academy Press, 2000.

    Google Scholar 

  2. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 2003, 290:1868–1874.

    Article  PubMed  CAS  Google Scholar 

  3. Batalden P, Leach D, Swing S, et al.: General competencies and accreditation in graduate medical education. Health Affairs 2002, 21:103–111.

    Article  PubMed  Google Scholar 

  4. Healy GB. The college should be instrumental in adapting simulators to education. Bull Am Coll Surgeons 2002, 11:10–12.

    Google Scholar 

  5. Liu A, Tendick F, Cleary K, et al.: A survey of surgical simulation: Applications, technology, and education. Presence 2003, 12:599–614.

    Article  Google Scholar 

  6. Passerotti CC, Passerotti AM, Dall’Oglio MF, et al.: Comparing the quality of the suture anastomosis and the learning curves associated with performing open, freehand, and robotic-assisted laparoscopic pyeloplasty in a swine animal model. Journal of the American College of Surgeons 2009, 208:576–86.

    Article  PubMed  Google Scholar 

  7. Brydges R, Farhat WA, El-Hout Y, Pediatric urology training: performance-based assessment using the fundamentals of laparoscopic surgery. Journal of Surgical Research 2010, 161:240–5.

    Article  PubMed  Google Scholar 

  8. Kishore TA, Pedro RN, Monga M, et al: Assessment of validity of an OSATS for cystoscopic and ureteroscopic cognitive and psychomotor skills. Journal of Endourology 2008, 22:2707–11.

    Article  PubMed  Google Scholar 

  9. •• McQuiston L, Macneily A, Liu D, et al.: Computer enhanced visual learning method to train urology residents in pediatric orchiopexy provided a consistent learning experience in a multi-institutional trial. Journal of Urology 2010, 184:1748–53. This manuscript represents one of a few in the literature that have tested surgical curricula for medical decision-making training specific to pediatric urologic disease. There are many articles addressing technical skills training for MIS, but teaching the cognitive aspects of open surgery remains one of the most challenging endeavors in surgical education.

    Article  PubMed  Google Scholar 

  10. Maizels M, Yerkes EB, Macejko A, et al.: A new computer enhanced visual learning method to train urology residents in pediatric orchiopexy: a prototype for Accreditation Council for Graduate Medical Education documentation. Journal of Urology 2008, 180:1814–8.

    Article  PubMed  Google Scholar 

  11. Jensen AR, Wright AS, Levy AE, et al: Acquiring basic surgical skills: is a faculty mentor really needed? American Journal of Surgery 2009, 197:82–8.

    Article  PubMed  Google Scholar 

  12. Jensen AR, Wright AS, McIntyre LK, et al.: Laboratory-based instruction for skin closure and bowel anastomosis for surgical residents. Archives of Surgery 2008, 143:852–8.

    Article  PubMed  Google Scholar 

  13. Peters JH, Fried GM, Swanstrom LL, et al. and the SAGES FLS Committee: Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 2004, 135: 21–27.

    Article  PubMed  Google Scholar 

  14. McCluney AL, Vassiliou MC, Kaneva PA, et al.: FLS simulator performance predicts intraoperative laparoscopic skill. Surgical Endoscopy 2007, 21:1991–5.

    Article  PubMed  CAS  Google Scholar 

  15. •• Van Nortwick SS, Lendvay TS, Jensen AR, et al.: Methodologies for establishing validity in surgical simulation studies. Surgery 2010, 147:622–30. This manuscript represents an exhaustive appraisal of existing surgical simulation curricula literature and offers a standard template for future surgical educators to draft validation studies. It highlights the realities of the limitations of the current simulation literature and presents recommendations for sound validation research.

    Article  PubMed  Google Scholar 

  16. Vemulakonda VM, Cowan CA, Lendvay TS, et al: Surgical management of congenital ureteropelvic junction obstruction: a Pediatric Health Information System database study. Journal of Urology 2008, 180:1689–92.

    Article  PubMed  Google Scholar 

  17. Lendvay TS, Casale P, Sweet R, et al.: VR robotic surgery: randomized blinded study of the dV-Trainer robotic simulator. Studies in Health Technology & Informatics 2008, 132:242–4.

    Google Scholar 

  18. Kenney PA, Wszolek MF, Gould JJ, et al.: Face, content, and construct validity of dV-trainer, a novel virtual reality simulator for robotic surgery. Urology 2009, 73:1288–92.

    Article  PubMed  Google Scholar 

  19. Lerner MA, Ayalew M, Peine WJ, et al.: Does training on a virtual reality robotic simulator improve performance on the da Vinci surgical system? Journal of Endourology 2010, 24:467–72.

    Article  PubMed  Google Scholar 

  20. Seixas-Mikelus SA, Kesavadas T, Srimathveeravalli G, et al.: Face validation of a novel robotic surgical simulator. Urology 2010, 76:357–60.

    Article  PubMed  Google Scholar 

  21. Haynes AB, Weiser TG, Berry WR, et al.: A surgical safety checklist to reduce morbidity and mortality in a global population. NEJM 2009, 360:491–499.

    Article  PubMed  CAS  Google Scholar 

  22. Do AT, Cabbad M, Kerr A, et al.: A warm-up laparoscopic exercise improves the subsequent laparoscopic performance of OB-GYN residents: A low-cost laparoscopic trainer. Journal of Laparoendoscopic Surgeons 2006, 10:297.

    Google Scholar 

  23. Kahol K, Satava R, Smith M, et al.: The effect of short term pre-trial practice on surgical proficiency in simulated environments: A randomized trial of “Pre-operative warm-up” effect. J Am Coll Surgeons 2008, 208:255–268.

    Article  Google Scholar 

  24. •• Calatayud D, Arora S, Aggarwal R, et al.: Warm-up in a virtual reality environment improves performance in the operating room. Annals of Surgery 2010, 251:1181–5. This manuscript is noteworthy for two reasons. First, it demonstrates the benefit of virtual reality training for operating room performance (predictive validity), which very rarely is described in the literature because of the difficulty in doing the study. Second, it demonstrates the benefit of a surgical warm-up using simulation technology, which promises to change how surgeons prepare themselves immediately before surgery.

    Article  PubMed  Google Scholar 

  25. Zhang Y, Sweet RM, Metzger GJ, et al.: Advanced finite element mesh model of female SUI research during physical and daily activities. Studies in Health Technology & Informatics 2009, 142:447–52.

    Google Scholar 

  26. Rosen J, Brown JD, De S, et al.: Biomechanical properties of abdominal organs in vivo and postmortem under compression loads. Journal of Biomechanical Engineering 2008, 130:021020-1-17.

    Article  Google Scholar 

  27. Okamura AM: Haptic feedback in robot-assisted minimally invasive surgery. Current Opinion in Urology 2009, 19:102–7.

    Article  PubMed  Google Scholar 

  28. Reiley CE, Akinbiyi T, Burschka D, et al.: Effects of visual force feedback on robot-assisted surgical task performance. Journal of Thoracic & Cardiovascular Surgery 2008, 135:196–202.

    Article  Google Scholar 

  29. Kitagawa M, Dokko D, Okamura AM, et al.: Effect of sensory substitution on suture-manipulation forces for robotic surgical systems. Journal of Thoracic & Cardiovascular Surgery 2005, 129:151–8.

    Article  Google Scholar 

  30. Kapoor A, Li M, Taylor RH: Spatial motion constraints for robot assisted suturing using virtual fixtures. Medical Image Computing & Computer-Assisted Intervention: MICCAI 2005, 889–96.

  31. Bettini A, Marayong P, Lang S, et al.: Vision-assisted control for manipulation using virtual fixtures. IEEE Transactions on Robotics 2004, 20:953–966.

    Article  Google Scholar 

  32. Ren J, Patel RV, McIsaac KA, et al.: Dynamic 3-D virtual fixtures for minimally invasive beating heart procedures. IEEE Transactions on Medical Imaging 2008, 27:1061–1070.

    Article  PubMed  Google Scholar 

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Department of Urology, University of Washington, Seattle, WA, USA

    Thomas Sean Lendvay

  2. Division of Pediatric Urology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Thomas Sean Lendvay

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  1. Thomas Sean Lendvay
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Correspondence to Thomas Sean Lendvay.

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Lendvay, T.S. Surgical Simulation in Pediatric Urologic Education. Curr Urol Rep 12, 137–143 (2011). https://doi.org/10.1007/s11934-011-0170-8

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