Department of Urology, University Hospital Linköping, Linköping, Sweden.
J Endourol. 2010 Sep;24(9):1521-8. doi: 10.1089/end.2009.0667.
There are virtual reality simulators for practicing the transurethral resection of prostate (TURP) procedure, but only few data on its effect on surgical performance are available. The purpose of this study was to test if practicing the TURP procedure in a virtual reality simulator (PelvicVision) increases the skills and dexterity of urology residents when performing the procedure on patients.
Twenty-four urology residents attended a 5-day course on diagnosis and treatment of benign prostatic enlargement. Each of the residents performed three video-recorded TURP procedures. Between two of the procedures (on day 2 and 3, or 3 and 4) the residents underwent criterion-based practice using a simulator. The TURP procedure was evaluated using objective structured assessment of technical skills. Video-recordings of the procedures were analyzed on a minute-to-minute basis.
Mean practice time in the simulator was 198 minutes before reaching the criterion level. Comparison of the first and last TURP procedures showed an increase in autonomous operation time and time spent on resection, and a tendency to decreased hemostasis time without increased blood loss. The proportion of residents believed to be able to perform a simple TURP procedure increased from 10% to about 75%. Objective structured assessment of technical skills scores and self-evaluations were significantly improved. The scores increased significantly more with than without simulator practice. The resident's self-evaluations showed increased knowledge about the procedure and the technical equipment used. Patient follow-up showed no increased risks.
Practice in a simulator-based environment improves the skills and dexterity of urology residents when performing the procedure on patients, without increased risks for the patients.
目前已有用于经尿道前列腺切除术（TURP）操作练习的虚拟现实模拟器，但有关其对手术操作效果的影响的数据却很少。本研究旨在检验在虚拟现实模拟器（PelvicVision）中练习 TURP 操作是否会提高泌尿科住院医师在患者身上实施该手术的技能和灵巧度。
24 名泌尿科住院医师参加了为期 5 天的关于良性前列腺增生症诊断和治疗的课程。每位住院医师都进行了 3 次录像 TURP 手术。在第 2 天和第 3 天或第 3 天和第 4 天之间，住院医师使用模拟器进行基于标准的练习。使用客观结构化手术技能评估来评估 TURP 手术。对手术过程进行逐分钟录像分析。
达到标准水平之前，在模拟器上的平均练习时间为 198 分钟。比较第一次和最后一次 TURP 手术，发现自主操作时间和切除时间增加，止血时间有减少的趋势，而失血量没有增加。认为能够进行简单 TURP 手术的住院医师比例从 10%增加到约 75%。客观结构化手术技能评估分数和自我评估均显著提高。与没有模拟器练习相比，分数提高得更为显著。住院医师的自我评估显示，他们对手术过程和所用技术设备的了解有所增加。患者随访未显示出增加的风险。
在基于模拟器的环境中进行练习可以提高泌尿科住院医师在患者身上实施该手术的技能和灵巧度，而不会增加患者的风险。
