V8-01: Full procedural simulation for transurethral resection of bladder tumors (TURBT) using 3-D printing technology.
Our understanding of simulation-based training is evolving from simply practicing basic and partial tasks to learning full procedures through an accurate re-creation in the operating room. However, for full procedural simulation to be effective it requires an artificially created learning situation, that allows for the rehearsal of all salient aspects of a procedure in the same order utilizing the same devices with the opportunity to enact both appropriate and inappropriate learner actions (i.e., errors). In this video we demonstrate a high fidelity, inexpensive, simulated inanimate model for physical learning experience in TURBT (S.I.M.P.L.E.-TURBT) that encompasses all fundamental aspects for an effective full procedural simulation, including procedure-based assessment metrics.
Using a proprietary method, anatomically correct models of the human bladder and relevant structures were created with poly-vinyl alcohol (PVA) hydrogels using 3-D printed molds. Individual bladder layers including mucosal, muscular, serosal and perivesival fat were created containing 3 tumors of varying size, location and depth of invasion. All steps of TURBT were simulated by 6 volunteer urologists. Expert designation was based on caseload (> 100 TURBT cases). Face validity was calculated by ratings of realism. Content validity was calculated by rating the usefulness of the model as a training tool. Construct validity was calculated by comparison of procedural metrics (Operative time, tumor margins, missed tumors, muscle layer sampling and complications) between the groups.
The model was determined to have good face and content validity with an average score of 4.3/5 and 4.1/5, respectively. A significant difference between expert and novice urologists was demonstrated in both total procedure time and time to resect the large vascular tumor. No difference in resection time was appreciated in the 2cm papillary non-vascular tumor. 66 % of the novice performance exhibited bladder perforations and a missed anterior wall tumor (Table 1).
Validation of our portable, inexpensive, high fidelity model offers a full procedural, TURBT simulation with the potential for training and maintenance of advanced procedural skills together with acquisition of procedure wisdom.