Læknablaðið : fylgirit - 01.06.2009, Qupperneq 17

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
24 Face, content and construct validity of a VR
simulation model for training in TURP
R Kállström', H Hjertberg2, J Svanvik3
Dept. of Urology, 'University Hospital Linköping and 2Vrinnevi Hospital
Norrköping, 3Dept ofSurgery, University Hospital Linköping, Sweden
reidar.kallstrom@lio.se
Aim: Learning outside the operating room provides practice in a
controlled fashion with increasing levels of difficulty whenever
there is time. Training in the basic skills of TURP has a long
learning curve (70-90 procedures). The purpose of this study
was to construct and to examine the face, content and construct
validity of a full procedure, virtual reality TUR-P simulator.
Materials and methods: The construction of the simulator
(PelvicVision) was based on a face validity study (17 urologists)
and a content validity study (9 urologists). The simulator
consists of a resectoscope connected to a robotic arm with haptic
feedback and foot pedals connected to a personal computer; the
picture of the prostatic urethra, the bladder and the resectoscope
tip is presented. The flow of irrigation fluid, the amount of
bleeding and the corresponding blood fog is calculated. The
movements, resection volumes, use of current, etc, is measured.
Data from the simulation were analyzed after performing 6 (11
students) and 3 (9 urologists) procedures with different levels of
difficulty.
Results and discussion: The students showed a positive
learning curve. The urologists were more effective, active and
careful. It is still necessary to evaluate the effect of simulator
training in the clinical situation.
Conclusion: There is proof of face, content and construct
validity for this simulator for training in TURP. The simulator
could be used in the early training of urology residents without
risk of negative outcome.
Key words: transurethral resection of prostate; computer
simulation; medical education; task performance and analysis.
25 An international survey of laparoscopic training
program during residency: simulation versus clinical
L Lund1, A Dubrowski2, DS HerrelP, K Kijvikai4, H Carnahan5
2Viborg, Denmark, 2Toronto, On, Canada, 3Nashville, TN, USA, 4Bangkok,
Thailand, 5Toronto, ON, Canada
dr.ll@dadlnet.dk
Aim: The widespread use of laparoscopy has created a growing
demand for uniformity in education and curriculum. Urologic
training in minimal invasive surgery should be based on theory
and principles that would lead to universal guidelines. To
begin the dialogue necessary to develop a unified educational
approach, and in an effort to understand the perceived needs
of trainees at an international level we evaluated the current
exposure to laparoscopic training programs and simulation at 11
institutions in three countries.
Material and methods: A 23 item, e-mail based questionnaire
was sent to 64 residents in Denmark, Thailand and United
States. Areas evaluated included: age. year of training, type of
hospital, exposure to low and high fidelity training, simulator
training, certification and exposure to performing laparoscopy.
Results: There was a 64% (43/67) response rate to the survey.
The participants came from Denmark (73%), Thailand (5%) and
t United States (22%). The majority of participants were between
the ages 30-34 years old. There were many differences between
the responses from the 3 countries such as type of hospital;
experience with real operations; experience with simulation
based courses; and the desire for certification in laparoscopic
procedures. Although the exposure to laparoscopic urological
surgery is highest in USA we found a difference between the
countries in offering laparoscopy courses to trainees (Thailand
(100%), Denmark (96%), USA (39%). However, a desire for
exposure to simulation based courses was shared by all
respondents, regardless of country.
Conclusions: Although a small sample size, thus some caution
must be used when interpreting the findings. However,
the present data are valuable as a helping guide for further
investigation into the need for international guidelines
in training programs and development of education and
simulation in urologic surgery for the next generation of
minimally invasive surgeons.
26 latrogenic injuries to the ureter and bladder. - A
follow-up of a large series
S Göthe, R Peeker
Department ofUrology, Sahlgrenska University Hospital, Gothenburg, Sweden
sofia.gothe@gmail.com
Background: There is always a potential risk of injury the
urinary tract during surgery in the lower abdomen and the
lesser pelvis. Injuries to the bladder and ureters are often
associated with significant morbidity such as infections and/or
loss of renal function.
Aim: The aim was to investigate the occurrence of iatrogenic
injuries to the bladder and the ureters, during which procedures,
diagnostics, mode of reconstruction and final outcome.
Method: All patients in our hospital diagnosed with an
iatrogenic injury to the urinary tract were studied between lst
January 2000 to the end of June 2007 (7.5 years). Data collected
included type of surgery, type of injury, measures to establish
the diagnosis and when this was done, how and when the
reconstruction took place and who performed it.
Result: 166 patients were found and 160 were selected.
Gynaecological procedures represented the majority of the
underlying cause, hysterectomy being the commonest. The
bladder and ureters were most commonly injured through
lacerations. For the vast majority of these patients, the result
after repair was fully satisfactory. However, quite many suffered
from infections preoperatively and a few patients experienced
some degree of deterioration of renal function.
Conclusions: It is imperative that these patients are treated by
surgeons/urologists in possession with adequate knowledge
and skill. The outcome for these patients is satisfactory in most
cases, especially when the injury is primarily recognised and
reconstructed. The road to healing can however be utterly
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