Noureldin Yasser A, Andonian Sero
1 Division of Urology, McGill University , Montréal, Québec, Canada .
2 Urology Department, Benha University Hospital, Benha University , Benha, Egypt .
J Endourol. 2017 Apr;31(S1):S10-S19. doi: 10.1089/end.2016.0587. Epub 2016 Oct 11.
Percutaneous renal access (PCA) is a challenging step during percutaneous nephrolithotomy. The aim of this study is to review the literature for different types of simulators described for PCA.
Databases of Medline, Embase, Cochrane Library, OvidSP, and Google Scholar were systematically searched until May 2016. The studies were analyzed regarding the type of simulator (nonbiologic, biologic, live animal, and virtual reality [VR]), type of validity (face, content, construct, and predictive), cost-effectiveness, and whether these simulators have been used for training and/or assessment of PCA. In addition, the study looked at the educational impact of these simulators in terms of the transfer of PCA skills to the operating room.
Several bench, animal, and VR simulators for training in PCA were identified. Only few studies were found on assessment of PCA skills. Biological bench models used porcine or bovine kidneys wrapped within foam, silicone, chicken carcass, or full-thickness skin flap alone. Other biological models used additional subcutaneous fascia, muscle, or ribs. Nonbiological models used prototypes, including 3D printing. Only one study reported the use of anesthetized live pig for training. The PERC Mentor™ was the only VR simulator, which has been validated for training and assessment of PCA skills. However, none of these studies assessed the educational impact of PCA simulators. Furthermore, most of the studies did not address the validity and the cost of the simulator.
While several biological and nonbiological PCA models exist, there is paucity of literature regarding the validity and educational impact of these simulators. The PERC Mentor simulator is the sole validated simulator for training and assessment of PCA skills. However, it is expensive and there is little evidence of its educational impact. Therefore, more research is needed to validate the available simulators and assess their educational impact for urology trainees.
经皮肾穿刺通道建立（PCA）是经皮肾镜取石术中具有挑战性的一步。本研究旨在回顾文献中描述的用于PCA的不同类型模拟器。
系统检索Medline、Embase、Cochrane图书馆、OvidSP和谷歌学术数据库直至2016年5月。分析这些研究中模拟器的类型（非生物、生物、活体动物和虚拟现实[VR]）、效度类型（表面效度、内容效度、结构效度和预测效度）、成本效益，以及这些模拟器是否已用于PCA的培训和/或评估。此外，该研究还考察了这些模拟器在将PCA技能转移到手术室方面的教育影响。
确定了几种用于PCA培训的实验台、动物和VR模拟器。关于PCA技能评估的研究很少。生物实验台模型使用包裹在泡沫、硅胶、鸡尸体或仅全层皮瓣内的猪或牛肾脏。其他生物模型还使用了额外的皮下筋膜、肌肉或肋骨。非生物模型使用原型，包括3D打印。只有一项研究报告了使用麻醉的活猪进行培训。PERC Mentor™是唯一一款已被验证可用于PCA技能培训和评估的VR模拟器。然而，这些研究均未评估PCA模拟器的教育影响。此外，大多数研究未涉及模拟器的效度和成本。
虽然存在几种生物和非生物PCA模型，但关于这些模拟器的效度和教育影响的文献较少。PERC Mentor模拟器是唯一一款经过验证可用于PCA技能培训和评估的模拟器。然而，它价格昂贵，且几乎没有证据表明其具有教育影响。因此，需要更多研究来验证现有的模拟器，并评估它们对泌尿外科实习生的教育影响。
