Current Status of Simulation Training in Urology: A Non-Systematic Review

Figures & data

Table 1 Types of Validity

Type of Validity	Definition
Face validity	Extent of a simulator’s realism assessed subjectively through surveys of user opinion, usually with Likert scale
Content validity	Extent to which a simulator’s content reflects knowledge and skills required in real life, based on surveys of expert opinion
Construct validity	Ability of the simulator to differentiate between the levels of experience of users or groups. This is proven when experts must outperform non-experts during standardized simulated tasks
Concurrent validity	Comparison of the new simulator’s performance against a gold standard
Predictive validity	Ability of a simulator to predict performance in real life. This is assessed by correlating task performance on the simulator with the performance in the operating theatre

Table 2 Models for Open Urology

Type of Model	Name	Skill	Provider	Validity
Bench	Male Rectal Examination Trainer	DRE prostate exam, anal tone and rectal exam	Limbs & Things UK	None
	Clinical Male Pelvic Trainer	Pelvic exam, testicular pathologies, penile cancer, indirect inguinal hernia	Limbs & Things UK	Face^Citation12
	Clinical Female Pelvic Trainer	Abdomen, pelvis, vagina, cervix, anus, different uterine modules (optional)	Limbs & Things UK	Face and Construct^Citation13
	Advanced Catheterization Trainer	Urethral and SPC	Limbs & Things UK	None
	Penile model + foreskin integrated in UroEmerge	Circumcision, penile ring block, priapism, paraphimosis	Pharmabotics + Limbs & Things	Face and content^Citation14
	Adult Male Circumcision Trainer	Circumcision	Limbs & Things	Face and content^Citation15
	Non-Scalpel Vasectomy Simulator	Vasectomy	Advanced Meditech International	Face^Citation16
	UroEmerge SPC Model	SPC	St Bartholomew Hospital London	Construct and predictive^Citation17
	SPC Model	SPC and urethral catheterization	Northwestern University Feinberg School of Medicine, Chicago	Face and content^Citation18
	SPC Model	SPC and urethral catheterization	Western Hospital, Melbourne, Australia	Face^Citation19
	VesEcho	SPC under US guidance	Dept. of Urology, Univ. of California, Sacramento	Face and content^Citation20
	US-SCIT	SPC under US guidance	Univ. of the Witwatersrand, Johannesburg, South Africa	Face and content^Citation21
	SPC Model	SPC	Xuanwu Hospital Beijing, China	None
	Ischemic Priapism Model	Ischemic priapism	University of Washington School of Medicine	Face and content^Citation22
Cadaveric	Fresh frozen	Emergency procedures, andrology	BAUS	Face, content^Citation23
	Thiel embalmed	Renal transplant	-	Face^Citation24

Abbreviations: DRE, digital rectal examination; SPC, suprapubic catheterization; US-SCIT, ultrasound-guided suprapubic catheter insertion trainer; BAUS, British Association of Urological Surgeons.

Table 3 Nonbiologic Models for Endourology

Type of Model	Name	Skill	Provider	Validity
Bench	ETXY-URO Simulator	CYS, Botox injection	ProDelphus, Brazil	Face and content^Citation29
		CYS, URS		Face, content and construct^Citation30
	Endoscopic Urinary Tract Model	CYS, URS	SimPortal, University of Minnesota, USA	None
	Resection Trainer LS10	TURBT	Samed GmbH, Dresden	Face, content and construct^Citation36
		TURP	Samed GmbH, Dresden	None
	Holmium laser enucleation simulator	HoLEP	Kansai Medical University, Osaka	Face and content^Citation37
	K-Box	URS	Coloplast	Content^Citation38 and construct^Citation39
	Cook URS	URS	Cook Medical USA	Face, content and construct^Citation40
	Advanced Scope Trainer	URS	Mediskills UK	Face, content, construct and concurrent^Citation41
	EndoUro-Trainer	URS	Samed GmbH, Dresden	None
	SIM-PCNL model	PCNL	University of Rochester, New York	Face, content and construct^Citation42
	iPERC	PCNL	Hospital de Especialidades, Mexico	Construct^Citation43
	PCNL trainer LS40	PCNL	Samed GmbH, Dresden	None
	Perc Trainer	PCNL	Mediskills UK	None
Virtual Reality	URO Mentor	CYS, Bladder biopsies	3D Systems formerly Simbionix	Face, content, construct and predictive^Citation44^–^Citation50
		URS		Face, content, construct, and predictive^Citation50^–^Citation54
	PERC Mentor	PCNL	3D Systems formerly Simbionix	Face, content, construct and predictive^Citation55^–^Citation57
	Uro Trainer TURBT	TURBT	Karl Storz, Germany	Face, content and construct^Citation58
	TURP Mentor	TURP	3D Systems formerly Simbionix	Face, content and construct^Citation59,Citation60
		TURBT		None
	SurgicalSIM TURP	TURP	HelSim Ltd, USA	Face, content and construct^Citation61,Citation62
	PelvicVision	TURP	Melerit Medical, Sweden	Face, content and construct^Citation63,Citation64
	VirtaMed UroS	TURP	VirtaMed, Switzerland	Face, content and construct^Citation65
		TURBT		None
		ThuLEP		None
		HoLEP		Face, content and construct^Citation66
		Diode PVP		Construct^Citation67
	GreenLight SIM	GreenLight PVP	UMN CREST for American Medical Systems, USA	Face, content and construct^Citation68
	RezumSim	Rezum	VirtaMed for NxThera	None
	UroLiftSim	UroLift	VirtaMed for Neotract	None

Abbreviations: CYS, cystoscopy; URS, ureterorenoscopy; TURBT, transurethral resection of bladder tumour; TURP, transurethral resection of prostate; HoLEP, holmium laser enucleation of prostate; PCNL, percutaneous nephrolithotomy; ThuLEP, Thulium laser enucleation of prostate; PVP, photoselective vaporization of prostate.

Table 4 Biologic Models for Endourology

Type of Model	Name	Skill	Provider	Validity
Cadaveric	Fresh frozen cadavers	CYS, Bladder biopsy, Botox injection, URS, TURP	BAUS	Face and content^Citation23
		CYS	–	Construct^Citation77
	Thiel embalmed cadavers	CYS, URS	–	Face and content^Citation78
		URS	–	Face and content^Citation79
		URS, TURP	–	Face^Citation80
		TURP, UroLift	University of Leeds, UK	None
Animal	Live porcine model	URS	–	Face, content and construct^Citation81
	Ex vivo porcine urinary tract	URS	–	Face, content and construct^Citation81
	Porcine kidney and ureter	PCNL	–	Face^Citation82
	Porcine bladder	Transurethral bulking	University of California, Irvine	Face, content and construct^Citation83
	Boar bladder	CYS, bladder biopsy	–	Construct^Citation84

Abbreviations: CYS, cystoscopy; URS, ureterorenoscopy; TURP, transurethral resection of prostate; BAUS, British Association of Urological Surgeons; PCNL, percutaneous nephrolithotomy.

Table 5 Laparoscopic Urology Models

Type of Model	Name	Skill	Provider	Validity
Bench	Partial Nephrectomy model	Lap. Partial Nephrectomy		Face, content and construct^Citation85,Citation86
	Ureteral anastomosis model	Ureteroneocystostomy	Cleveland Clinic, Ohio	Face, content and construct^Citation87
	Urethrovesical model	Urethrovesical anastomosis	University of Sherbrooke, Canada	Face and concurrent^Citation88
	Urethrovesical model	Urethrovesical anastomosis	Minimally Invasive Centre of Surgery Jesus Uson, Spain	Face, content and construct^Citation89
Virtual Reality	Lap Mentor	Lap. Radical Nephrectomy	3D Systems formerly Simbionix	None
	LapSim	Lap. Radical Nephrectomy	Surgical Science, Sweden	None
Animal	Rabbit model	Lap. Nephrectomy	–	Construct^Citation90
	Porcine bladder	Pyeloplasty	–	Construct^Citation91
	Chicken crop model	Pyeloplasty	–	Construct^Citation92
	Chicken model	Ureteric reimplantation	–	Face, content and construct^Citation93
	Chicken chest model	Urethrovesical anastomosis	–	Contruct^Citation94
	Chicken skin model	Urethrovesical anastomosis	–	Construct^Citation95
	Porcine intestine model	Urethrovesical anastomosis	–	Construct^Citation96
	Live female pig	Urethrovesical anastomosis	–	Face^Citation88
	Live pigs	Lap. radical nephrectomy, cystectomy	University of Medicine and Pharmacy Cluj-Napoca, CLERU, Romania	None
Cadaveric	Thiel embalmed cadavers	Lap. Radical Nephrectomy	University of Leeds, UK	Face, content and construct^Citation98

Table 6 Robotic Urology Models

Type of Model	Name	Skill	Provider	Validity
Virtual Reality	dVSS	Basic skills	Intuitive Surgical, USA	Face, content, construct, concurrent and predictive^Citation99^–^Citation101
	dV-Trainer	Basic skills	Mimic Technologies, USA	Face, content, construct, concurrent and predictive^Citation99^–^Citation102
	FlexVR	Basic skills	Mimic Technologies, USA	None
	RobotiX Mentor	Basic skills	3D Systems formerly Simbionix	Face, content and construct^Citation100,Citation101,Citation103
		RARP		Face, content and construct^Citation104
	RoSS	Basic skills	Simulated Surgical Systems, USA	Face, content and construct^Citation100,Citation101
		Urethrovesical anastomosis AR*		Concurrent^Citation105
		RARP		None
		RARC		None
		Lymph node dissection		None
	Tube-3	Urethrovesical anastomosis	Mimic Technologies, USA	Face, content, construct, concurrent and predictive^Citation106^–^Citation108
	Maestro AR*	RAPN	Mimic Technologies, USA	Face, content, construct and concurrent^Citation109
		RARP		None
	Xperience Team Trainer	Assistant skills	Mimic Technologies, USA	Face, content, construct and concurrent^Citation110
Bench	Mimic dry-lab exercises	Basic skills	Mimic Technologies, USA	Face, content and construct^Citation111
	SIMPLE-PN	RAPN	University of Rochester, USA	Face, content, construct and concurrent^Citation112,Citation113
	RAPN Training	RAPN	Washington University, St Louis USA	Face, content and construct^Citation114
	Urethrovesical model	Urethrovesical anastomosis	University of Texas, Dallas USA	Face, content and construct^Citation115
	Urethrovesical model	Urethrovesical anastomosis	Geisel School of Medicine at Dartmouth	Face and content^Citation116
Animal	Porcine kidney with an embedded Styrofoam ball	RAPN	–	Face, content and construct^Citation117
	Porcine bowel	Intracorporeal bowel anastomosis	–	Face, content and construct^Citation118
	Chicken model	Urethrovesical anastomosis	–	Face and content^Citation119
	Porcine genitourinary tract	RARP	–	Face, content and construct^Citation120
Cadaveric	Fresh frozen cadavers	Basic skills	–	Face and content^Citation121
		RARP	–	Face^Citation122

Abbreviations: dVSS, da Vinci Skills Simulator; RARP, robotic-assisted radical prostatectomy; RoSS, Robotic Surgery Simulator; AR*, augmented reality; RARC, robotic-assisted radical cystectomy; RAPN, robotic-assisted partial nephrectomy.

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