Impact of Virtual Reality-Simulated Training on Urology Residents' Performance of Transurethral Resection of the Prostate

Purpose: There are virtual reality simulators for practicing the transurethral resection of prostate (TURP) procedure, but only few data on its effect on surgical performance are available. The purpose of this study was to test if practicing the TURP procedure in a virtual reality simulator (PelvicVision) increases the skills and dexterity of urology residents when performing the procedure on patients. Materials and Methods: Twenty-four urology residents attended a 5-day course on diagnosis and treatment of benign prostatic enlargement. Each of the residents performed three video-recorded TURP procedures. Between two of the procedures (on day 2 and 3, or 3 and 4) the residents underwent criterion-based practice using a simulator. The TURP procedure was evaluated using objective structured assessment of technical skills. Videorecordings of the procedures were analyzed on a minute-to-minute basis. Results: Mean practice time in the simulator was 198 minutes before reaching the criterion level. Comparison of the first and last TURP procedures showed an increase in autonomous operation time and time spent on resection, and a tendency to decreased hemostasis time without increased blood loss. The proportion of residents believed to be able to perform a simple TURP procedure increased from 10% to about 75%. Objective structured assessment of technical skills scores and self-evaluations were significantly improved. The scores increased significantly more with than without simulator practice. The resident's self-evaluations showed increased knowledge about the procedure and the technical equipment used. Patient follow-up showed no increased risks. Conclusions: Practice in a simulator-based environment improves the skills and dexterity of urology residents when performing the procedure on patients, without increased risks for the patients.