Simulation-based enucleation training: A first experience using 3D-printed organ phantoms
Claudia Deyirmendjian1, David-Dan Nguyen2, Sero Andonian3, Mélanie Aubé-Peterkin3, Julien Letendre4, Dean Elterman5, Kevin C. Zorn6, Bilal Chughtai7, Peer Fischer8,9, Tian Qiu8,9, Arkadiusz Miernik10, Andreas Gross11, Naeem Bhojani6.
1Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 2Faculty of Medicine, McGill University, Montreal, QC, Canada; 3Division of Urology, McGill University Health Centre, Montreal, QC, Canada; 4Division of Urology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada; 5Division of Urology, University Health Network, Toronto, ON, Canada; 6Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; 7Department of Urology, Weill Cornell Medical College, New York, NY, United States; 8Micro Nano and Molecular Systems Lab, Max Planck Institute for Intelligent Systems, Stuttgart, Germany; 9Institute for Physical Chemistry, University of Stuttgart, Stuttgart, Germany; 10Department of Urology, University of Freiburg, Freiburg, Germany; 11Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
Introduction: Anatomical endoscopic enucleation of the prostate (AEEP) is an effective treatment for benign prostatic hyperplasia (BPH) but it is a urological surgery with a steep learning curve. Simulator-based training is designed to mimic real-life AEEP, and ideally should help surgeons develop skills they can transfer to the operating room. This study aimed to evaluate the validity of a novel organ phantom for use in AEEP simulation training.
Methods: Participants practiced AEEP on simulators during a MasterClass hosted by the Canadian Urological Association using one of three lasers: holmium, thulium, and bipolar. The organ phantom is composed of hydrogels and uses 3D molds to recreate prostatic tissue and anatomy (Figure 1). Participants completed a questionnaire assessing content and face validity, as well as feasibility and acceptability of using the organ phantom in training.
Results: The novice group consisted of 12 urologists with an average of 11.7 years of practice and one urology resident. The median number of prior AEEP performed by trainees was 0 (interquartile range 0–2). Two experts in AEEP, who have performed at least 100 cases, also participated. All participants agreed or strongly agreed that there is a role for simulators in general surgical training and specifically in AEEP training. Participants positively rated the overall operative experience (7.3/10). Creating the 5, 6, or 7 o’clock groove and the anterior commissure (7.9/10) were the most realistic steps of enucleation; morcellation (4.7/10) and hemostasis (3.1/10) were the least (Figure 2). All participants considered it feasible to incorporate this organ phantom into training programs and 92.9% agreed that it teaches skills transferrable to the operating room (Figure 3).
Conclusions: This study has established content and face validity for AEEP with three different energy sources on an organ phantom. Participants considered its use both feasible and acceptable for AEEP training purposes.
