V406: GreenLight Simulator to learn GreenLight therapy : presentation and prospective evaluation

V406: GreenLight Simulator to learn GreenLight therapy : presentation and prospective evaluation


Introduction and Objectives
The GreenLight Sim has been recently engineered by the Center of Research in Education and Simulation Technologies (University of Minnesota) to improve the skill of novice surgeons for GreenLight therapy. The purpose of this video was to present this new training tool and report the results of its prospective evaluation.

The training curriculum of the GreenLight Sim includes 5 port-task exercises called « training modules » and 6 « common cases » which are virtual procedures based on 6 different prostatic anatomies.

Between August and October 2012, 11 participants divided into 3 groups according to their initial surgical training were prospectively evaluated on the « small normal gland » procedure using a reference surgical technique previously described by the expert of our team. The groups were defined as follows : group 1=1 expert (>100 procedures); group 2=4 surgeons (10-60 procedures) and group 3=6 residents (0 procedures).The participants performed the exercice 4 times and the results were compared to those of the expert. The fourth attempt was performed after advices from the expert. Criteria of efficiency (sweep speed, fiber-tissue distance, energy delivered, vaporization time,…), safety for patient (capsular perforation, bladder neck or sphincter damage,…) and safety for medical equipment (scope or lens or fiber damage) were assessed. A subjective evaluation of the GreenLight Sim was also made using an online questionnaire to evaluate utilization, ergonomy, realism, and reliability .

The reference values were defined by the expert and compared with those of the 2 groups. The results of novices reached these values at first attempt and were constant for efficiency criteria (92 to 111% of the reference value) and for sphincter or ureteral injury (0 injury). There was more capsular perforations and bladder neck damages at first attempt (x6 and x12 respectively) with gradual decrease to reach experts values at fourth attempt. Similar results were observed for group 2, with lower bladder neck damages or capsular perforations at the first attempt, and with faster improvement.

The quality and realism of the software were considered high (4/5). However, the access to the keyboard during exercise, especially for scope calibration, was considered low (2/5).

The GreenLight Simulator allows an improvement of surgeons skill by increasing the safety for patient and material equipment during the procedure. It seems to be a valid tool for training, and its impact on the learning curve must be assessed by prospective studies.

Funding: none