It is well known that like training for most procedures, urological training for percutaneous access is limited outside of the operating room and is isolated to either bench models, animal kidneys, live porcine models, and simulators. However, Dr. Wason believes that novel iVR technology can be used to train residents and, if done well, can somewhat replicate an intraoperative environment. It was the aim of his study to evaluate the efficacy of a novel iVR simulator to teach residents how to better perform and execute PCNL tract access.
In this single-institution study, urology and interventional radiology (IR) residents were recruited to establish percutaneous access into the posterior lower pole calyx in the prone position using this iVR simulator. A Likert type scale was used to record the participant’s VR experience while the robotic arm recorded kinematic parameters to assess economy of motion (how effective and fast someone was to achieve posterior access).
What Dr. Wason and his team discovered was that the vast majority of participants believed that the iVR simulator was very realistic (over 95%). In terms of the overall realism of the iVR model and experience, participants reported an average realism score of 3.5/5. With regard to hand-eye coordination, most participants found that the iVR simulator was very accurate and seamless. In terms of the quality and overall comfort and performance of the simulator, participants felt that their experience was roughly a 4/5 in how effective they felt the simulator was with regards to modeling a real PCNL access.
In conclusion, Dr. Wason and his team found that immersive VR simulation for PCNL access is a unique platform for surgical education, which was rated favorably amongst participants. The training platform, however, was unable to differentiate between novices and experts, which is one major area of concern and future research as this study continues to evolve. Further improvements, such as a need for haptic feedback, fluoroscopy, and procedural steps, should also be incorporated into future studies.
Presented by: Shaun Wason, MD, Department of Urology, Boston Medical Center, Boston, Massachusetts
Written By: Andrew Shea Afyouni, BS, Junior Research Specialist and Medical Student, University of California, Irvine Department of Urology at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd Abu Dhabi, UAE.