Abstract: PD41-05
Sources of Funding: This work was partially sponsored by Fonds de la Recherche Sante du Quebec (FRSQ) grants to Dr Mehdi Aloosh and Dr Sero Andonian and by a grant from the Urology Care Foundation Research Scholars Program and the Boston Scientific Corporation, The Endourological Society, and the_x000D_ &[Prime]Friends of Joe&[Prime] and the Canadian Urological Association-Societe Internationale d&[prime]Urologie (CUA-SIU) Scholarship to Dr Yasser Noureldin.

Introduction

Ureteroscopic stone extraction is the gold standard for management of ureteral and some renal stones. To_x000D_ achieve competency in performing this minimally invasive procedure and decrease the chance of potential complications adequate training is essential. However,_x000D_ there are concerns whether training exclusively in the operating theatre is adequate to achieve competency. Thus, simulators were introduced for training in a_x000D_ radiation and stress-free environment. UroMentor^TM simulator (Simbionix, Cleveland, Ohio, USA) has been validated for training ureteroscopy. However there is no data on the learning curve of ureteroscopic stone extraction on the simulator. Moreover, it is unknown whether skills acquired on this simulator are transferable to the operating theatre. Therefore, the aim of this study was to assess the learning curve of flexible ureteroscopic stone extraction and transfer of the skill obtained from the simulator to the operating theatre.

Methods

After obtaining ethics approval, Post Graduate Trainees (PGTs) from PGY1-4 were recruited. During phase I, participants completed three weekly one-hour training sessions on the UroMentor^TM simulator practicing task 10, where two small stones from the left proximal ureter and renal pelvis were extracted using a basket. Assessments from the simulator and the validated Ureteroscopy-Global Rating Scale (URS-GRS) were used to establish the learning curve. During phase II, the URS-GRS tool was used to assess performance of participants in the operating theatre.

Results

In phase I, eight right-handed urology PGTs (PGY1-4) with mean age of 27.8±2 (25-31) years participated. PGTs practiced a total of 52 times, with a mean fluoroscopy time of 10.4±12 seconds and a mean operative time of 14.6±4.3 minutes. Competency in the task was achieved after seven trials on the simulator. In phase II, five PGTs were assessed while performing 55 consecutive flexible ureteroscopic stone extraction procedures in the operating room. The mean operative time was 51.4±15.2 minutes and the mean fluoroscopy time was 29±6 seconds. There was a significant correlation between URS-GRS scores obtained on the simulator and in the operating theatre (r=0.9, p=0.03).

Conclusions

Competency in performing flexible ureteroscopic stone-extraction on the UroMentor simulator was achieved after seven trials. Since there was a strong correlation between URS-GRS scores on the simulator and in the operating theatre, this skill could be transferred from the simulator the_x000D_ operating theatre.

Funding

This work was partially sponsored by Fonds de la Recherche Sante du Quebec (FRSQ) grants to Dr Mehdi Aloosh and Dr Sero Andonian and by a grant from the Urology Care Foundation Research Scholars Program and the Boston Scientific Corporation, The Endourological Society, and the_x000D_ &[Prime]Friends of Joe&[Prime] and the Canadian Urological Association-Societe Internationale d&[prime]Urologie (CUA-SIU) Scholarship to Dr Yasser Noureldin.