Review of trainers for transurethral resection of the prostate skills.

Performance of transurethral resection of the prostate and bladder involves the ability to work in a small three-dimensional space while receiving two-dimensional visual feedback. The operation also demands adept psychomotor abilities, as one has to navigate the resectoscope and the loop continuously and simultaneously while managing the electrical current with the use of both hands and a foot pedal. The fact that the procedure is performed in a fluid environment and that the field often is obscured is an important factor to consider when creating a teaching tool, as the debris and blood can be disorienting to the resectionist in training. Historically, this training problem was addressed with sheer case volume, but the number of procedures performed during a residency has declined. Limbs and Things (Bristol, UK) created a synthetic "physical" disposable model of the prostate that allows the user to practice basic cutting skills. No usability or validation studies have been published on this model. Several virtual-reality (VR) TURP simulators have been described, with varying degrees of preliminary validation studies. The University of Washington VR TURP Trainer is licensed to Medical Education Technologies, Inc. (METI, Sarasota, FL). A force-feedback device has been integrated. The simulator has an integrated curriculum with subtask exercises, such as navigation, cutting, coagulation, and full resection modules. It logs motion and force data, as well as operative errors, grams of tissue resected, blood loss, irrigant volume, foot pedal use, and differential time spent with orientation, cutting, or coagulation. An AHRQ-funded multi-institutional predictive validity study is in progress, examining this simulator's ability to improve residents' performance in the operating room.