Assessment of basic endoscopic performance using a virtual reality simulator - 01/09/11

Doi : 10.1016/S1072-7515(02)01346-7

David M Wilhelm, MD ^*,^†, Kenneth Ogan, MD ^*,^†, Claus G Roehrborn, MD, FACS ^*,^†, Jeffery A Cadeddu, MD ^*,^†, Margaret S Pearle, MD, PhD, FACS ^⁎,^*,^{^{1
Dr Pearle is a consultant for Applied Medical, a consultant and lecturer for Circon ACMI, and a scientific study participant with Boston Scientific. Dr Roehrborn is a consultant, investigator, and scientific study participant with financial support from Abbott Laboratories; a consultant, scientific study participant, and member of Data Safety and Monitoring Board for American Medical Systems; a consultant, investigator, and scientific study participant (all with financial support) for Merck and Glaxo Wellcome; a consultant with financial support from Sanofi-Synthelabo; an investigator and scientific study participant (with financial support) for Urologix, Eli Lilly, and NIH/NIDDK, and VA Cooperative Studies; and an investigator and scientific study participant for the Southwest Oncology Group.}}
^* Department of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
^† The Southwestern Center for Minimally Invasive Surgery, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

^*Correspondence address: Margaret S Pearle, MD, PhD, FACS, Department of Urology, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd,Dallas, TX 75390-9110, USA.

Abstract

Background

The objective of this study was to evaluate the effect of supervised training using a state-of-the-art virtual reality (VR) genitourinary endoscopy simulator on the basic endoscopic skills of novice endoscopists.

Study design

We evaluated 21 medical students performing an initial VR case scenario (pretest) requiring rigid cystoscopy, flexible ureteroscopy with laser lithotripsy, and basket retrieval of a proximal ureteral stone. All students were evaluated with objective parameters assessed by the VR simulator and by two experienced evaluators using a global rating scale. Students were then randomized to a control group receiving no further training or a training group, which received five supervised training sessions using the VR simulator. All students were then evaluated again in the same manner using the same case scenario (posttest).

Results

Comparing the results of pre- and posttests, no major differences were demonstrated for any variable in the control group. In the trained group, posttest results revealed statistically significant improvement from baseline in the following parameters: total procedure time (p = 0.002), time to introduce a ureteral guidewire (p = 0.039), self-evaluation (p < 0.001), and evaluator assessment (p < 0.001). Comparing the posttest results of the control and trained arms, we found significantly better posttest scores in the trained group for the following parameters: ability to perform the task (p = 0.035), overall performance (p = 0.004), and total evaluator score (p = <0.001).

Conclusions

Students trained on the VR simulator demonstrated statistically significant improvement on repeat testing, but the control group showed no improvement. Endourologic training using VR simulation facilitates performance of basic endourologic tasks and might translate into better performance in the operating room.

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