Content Validity Evidence for a Novel Mixed Reality Percutaneous Nephrolithotomy Simulator

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Advances in simulation technology continue to push the field of surgical education forward. Coupling immersive virtual reality (VR) simulation with a physical console allows the incorporation of haptic feedback into a virtual operating room, to more accurately simulate the technical steps of advanced surgical procedures. The Marion K181 PCNL Simulator is a mixed-reality percutaneous nephrolithotomy (PCNL) platform, designed to train users to navigate the pelvicalcyeal system.


Participants from three endourology centres in the United States and Canada completed a stone-retrieval scenario using the Marion K181 PCNL Simulator. Under non-testing conditions, participants interacted with all aspects of the immersive simulation operating room using a HTC VIVE VR headset (Taipei, Taiwan) and a nephroscope and grasper connected to two 6-degrees of freedom (DOF) haptic robots (Figure-1). The introductory module comprised retrieving 10 stones from the renal pelvis, removing them sequentially from the patient. Participants completed an exit questionnaire to provide demographic information, and 7-point Likert-scales allowed participants to grade the fidelity and functional task alignment of the simulator.


There were 30 participants: 7 students (23%), 6 residents (20%), 6 fellows (20%), and 11 experienced surgeons (37%). Overall, participants felt that the immersive, 3D aspect of the simulator provided a benefit over traditional 2D platforms (6.38/7). They felt that it provided adequate visual realism (5.07/7), tactile feedback (4.79/7), anatomic realism (5.07/7), and overall functional task alignment (4.81/7). Participants felt that the simulator is useful for the training (6.08/7) and assessment (5.38/7) of PCNL, especially amongst staff surgeon participants (6.8/7 and 5.8/7 respectfully).


This mixed-reality simulation platform is among the first of its kind in surgical education, and to our knowledge is the first in PCNL. We provide early data supporting its use in both the training and assessment of this complex endourologic procedure. The Marion K181 PCNL Simulator has potential to become an important training and assessment simulator for PCNL.

Funding: none