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

Abstract

Introduction: Anatomical endoscopic enucleation of the prostate (AEEP) is an effective treatment for benign prostatic hyperplasia (BPH); however, there is controversy regarding the difficulty of learning such a technique. Simulation-based training can mimic real-life surgeries and help surgeons develop skills they can transfer to the operating room, thereby improving patient safety. This study aims to evaluate the validity of a novel organ phantom for use in AEEP simulation training. Methods: Participants performed AEEP on organ phantom simulators during a masterclass using one of three energy modalities: holmium:YAG laser, thulium fiber laser, or bipolar energy. The organ phantom is composed of hydrogels and uses 3D molds to recreate prostatic tissue. Participants completed a questionnaire assessing content validity, face validity, feasibility, and acceptability of using the prostate organ phantom. Results: The novice group consisted of 13 urologists. The median number of AEEP previously performed was 0 (interquartile range [IQR] 0–2). Two experts in AEEP (surgeons having performed over 100 AEEP interventions) also participated. All participants agreed or strongly agreed that there is a role for simulators in AEEP training. Participants positively rated the overall operative experience (7.3/10). Morcellation (4.7/10) and hemostasis (3.1/10) were deemed the least realistic steps. All participants considered it feasible to incorporate this organ phantom in training programs and 92.9% agreed that it teaches skills transferrable to the operating room. Conclusions: This study has established content and face validity for AEEP with three different energy sources for an organ phantom. Participants considered its use both feasible and appropriate for AEEP training purposes.

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

“…Disadvantages of these VR simulators such as the lack of real lasers or practice of safe laser protocol can be overcome by concomitant use of bench-top simulators such as the Kansai HoLEP simulator which employ real instruments and lasers. 3D printed organ phantoms have been validated for prostate enucleation procedures [ 15 ▪ , 16 ] and these also carry such benefits but unlike VR simulators, they inadequately simulate morcellation.…”

Simulation training in urology

“…3D-printing is one of the most active and innovative areas of urologic simulation with researchers producing both surgical and procedural training models as well as patient-specific models for surgical preparation. Within the last year, physical 3D-printed models have been developed for urologic procedures including cystoscopy/ureteroscopy with kidney stone removal, trans-anal prostate biopsy, anatomical endoscopic enucleation of the prostate, and percutaneous kidney puncture [8–10,11 ▪ ,12–15]. In addition, 3D-printed models have also been produced for more invasive procedures such as robot-assisted kidney transplant and renal cell carcinoma resection [16].…”

3D-printing better urologists?

“…I n this edition of the CUAJ, Deyirmendjian et al describe their participant and proctor experience at a two-day anatomical endoscopic enucleation of the prostate (AEEP) masterclass, highlighting novel integration of 3D-printed prostate models. 1 Despite AEEP techniques demonstrating durable and effective outcomes for the past 20 years, the historically discouraging, "steep learning curve," has only recently become an exciting area of training-focused research.…”