Objectives To provide a training tool to address the technical challenges of robot-assisted laparoscopic partial nephrectomy, we created silicone renal tumor models using 3D printed molds of a patient's kidney with a mass. In this study, we assessed the face, content, and construct validity of these models. Materials and Methods Surgeons of different training levels completed four simulations on silicone renal tumor models. Participants were surveyed on the usefulness and realism of the model as a training tool. Performance was measured using operation specific metrics, self-reported operative demands (NASA TLX), and blinded expert assessment (GEARS). Results 24 participants included attending urologists, endourology fellows, urology residents, and medical students. Post-training surveys of expert participants yielded mean results of 79.2 on the realism of the model's overall feel and 90.2 on the model's overall usefulness for training. Renal artery clamp times and GEARS scores were significantly better in surgeons further in training (p≤0.005, p≤0.025). Renal artery clamp times, preserved renal parenchyma, positive margins, NASA TLX, and GEARS scores were all found to improve across trials (p<0.001, p=0.025, p=0.024, p≤0.020, p≤0.006 respectively). Conclusions Face, content, and construct validity were demonstrated in the use of a silicone renal tumor model in a cohort of surgeons of different training levels. Expert participants deemed the model useful and realistic. Surgeons of higher training levels performed better than less experienced surgeons in various study metrics, and improvements within individuals were observed over sequential trials. Future studies should aim to assess model predictive validity, namely the association between model performance improvements and improvements in live surgery.
Urology. 2018 Feb 05 [Epub ahead of print]
Steven M Monda, Jonathan R Weese, Barrett G Anderson, Joel M Vetter, Ramakrishna Venkatesh, Kefu Du, Gerald L Andriole, Robert S Figenshau
Division of Urological Surgery, Washington University School of Medicine. Electronic address: ., Division of Urological Surgery, Washington University School of Medicine.