Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy.
Urology Department, Hull University Teaching Hospital, Hull, United Kingdom.
J Endourol. 2023 May;37(5):607-614. doi: 10.1089/end.2022.0847. Epub 2023 Apr 12.
Novel training modalities are being investigated to overcome the challenges associated with learning retrograde intrarenal surgery (RIRS). Consequently, a series of 3D printed models of the upper urinary tract and stones designed for surgical simulation was introduced in 2021. This study aims to provide external validation of the training model and assess its role in the development of surgical skills. A mixed cohort of 20 urologists at different levels of expertise participated in a whole-day live simulation event to examine the model and perform a timed simulation of intrarenal navigation, stone relocation, and laser fragmentation. Operative times were recorded and two independent expert endourologists scored the simulations according to a modified "Objective Structured Assessment of Technical Skills" (OSATS) scale. Five novice urologists from the cohort performed three further simulations in a subsequent event to assess improvement in surgical skills. Face validity was demonstrated with a median score of ≥4/5 in each of the 11 items investigated. Content validity was also effectively reached, with 100% positive impressions with regard to the usefulness for the acquisition of surgical skills. Significant differences were observed among operative times stratified per surgeon experience (all < 0.0050), thus providing construct validity. Median total OSATS score for novices was 14 (range 8, 25) and was found to be significantly different from expected expert performance ( = 0.0010). Repeated simulations by novices led to a progressive reduction of operative times ( = 0.0313) and increase in median total OSATS ( = 0.0625). The 3D printed models of upper urinary tract and synthetic training stones for the high-fidelity simulation of each phase of RIRS were validated by this study. The results encourage the usage of the models in simulation courses and the evaluation of their potential role in standardized training curricula.
正在研究新的培训模式，以克服与逆行肾内手术（RIRS）相关的挑战。因此，2021 年推出了一系列用于手术模拟的上尿路和结石 3D 打印模型。本研究旨在对外科模拟模型进行外部验证，并评估其在手术技能发展中的作用。
一个由 20 名不同专业水平的泌尿科医生组成的混合队列参加了为期一天的现场模拟活动，以检查模型并进行肾内导航、结石重定位和激光碎石的定时模拟。记录手术时间，并由两名独立的内镜泌尿科专家根据改良的“客观结构化评估技术技能”（OSATS）量表对模拟进行评分。队列中的 5 名新手泌尿科医生在随后的活动中进行了另外 3 次模拟，以评估手术技能的提高。
在调查的 11 项内容中，每项内容的中位数均≥4/5，表现出良好的表面有效性。内容有效性也得到了有效实现，对于获得手术技能的有用性，有 100%的积极印象。根据外科医生经验对手术时间进行分层，观察到显著差异（均<0.0050），因此具有结构有效性。新手的总 OSATS 中位数评分为 14 分（范围为 8 至 25 分），明显低于预期的专家表现（=0.0010）。新手的重复模拟导致手术时间逐渐减少（=0.0313），总 OSATS 中位数增加（=0.0625）。
本研究验证了用于 RIRS 各个阶段高保真模拟的上尿路和合成训练结石的 3D 打印模型。结果鼓励在模拟课程中使用这些模型，并评估它们在标准化培训课程中的潜在作用。
