Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

Abstract

Background Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates ( N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations A total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.

Virtual reality vs. physical models in surgical skills training. An update of the evidence

“…Physical simulators such as bench-top tissue and food-based models also inadequately simulate bleeding for these procedures and carry hygiene risks, but are lower cost and beneficial in that they use real instruments. In the context of laser-based procedures, cadavers demonstrate content validity for holmium laser AEEP training [ 13 ] with superior anatomical fidelity to VR simulators and other physical simulators. Highly-rated aspects of cadavers included their provision of anatomic landmarks and realistic simulation of creating the layer between the adenoma and prostate capsule.…”

Effect of Self-Training Using Virtual Reality Head-Mounted Display Simulator on the Acquisition of Holmium Laser Enucleation of the Prostate Surgical Skills

“…The need for a systematic learning program to solve these shortcomings has been raised, and surgical training simulators have been developed [ 9 ]. These simulators include a synthetic bench model [ 9 , 10 ], an animal and human cadaver model [ 11 ], as well as a computer-assisted virtual reality (VR) simulator [ 12 ]. Existing biological tissue-based simulators have limitations in practical application due to cost issues and the limited number of uses [ 13 ].…”

Simulation-based prostate enucleation training: Initial experience using 3D-printed organ phantoms

“…19 Human cadavers are another tool for surgical training in AEEP that can create a highly realistic operative experience, including equipment, set-up and morcellation, however they lack bleeding and their availability is limited. 20,21 The novel prostate organ phantom engineered by the Max Planck Institute is composed of hydrogels and uses 3D moulds to recreate prostatic tissue and anatomy. While this model has been used successfully to teach TURP to urologists it has not yet been validated for AEEP surgical training.…”