title: Virtual reality ureteroscopy simulator as a valid tool for assessing endourological skills.
abstract: OBJECTIVE
  Virtual reality (VR) simulators are now commercially available for various surgical skills training. The Uro Mentor VR Ureteroscopy Simulator by Symbionix is one system that may revolutionize the way we assess and teach surgical residents. Surgical educators may no longer have to depend on the operating room as the sole venue for teaching residents technical skills. We validated performance on this new system with previously developed assessment tools and compared it to performance on a high fidelity ureteroscopy bench model.
  
  
  METHODS
  Urology residents (n = 16) were assessed on their ability to perform cystoscopy, guidewire insertion, semirigid ureteroscopy and basket extraction of a distal ureteric stone on the VR simulator. A blinded examiner assessed subject performance using a checklist, global rating scale and a pass/fail rating. In addition, computer-generated parameters including time to complete task, scope and instrument trauma and the number of attempts to insert a guidewire were analysed. Performance on the VR simulator was compared to performance on a high fidelity ureteroscopy bench model.
  
  
  RESULTS
  Senior residents (n = 8) scored significantly higher on their global rating scale (29.4 +/- 2.5 vs 20.8 +/- 0.9, P = 0.005), checklist (19.1 +/- 1.1 vs 15.2 +/- 0.9, P = 0.02), pass/fail rating (chi(2) = 7.3, P = 0.007) and required less time to complete the task (352.9 +/- 55.7 s vs 576.8 +/- 67.4 s., P = 0.02) than the junior residents (n = 8) on the VR simulator. Junior residents also had a significantly higher incidence of scope trauma (4 vs 0.6, P = 0.02). No significant differences were noted in instrument trauma and the number of attempts to insert the guidewire. Global rating scale performance on the VR simulator correlated well to performance on the high fidelity ureteroscopy bench model (r = 0.7, P = 0.002) as did time to complete task (r = 0.7, P = 0.004).
  
  
  CONCLUSIONS
  The Uro Mentor VR Ureteroscopy Simulator is a useful tool in assessing resident endourological skills. Performance on the VR simulator is comparable to a validated high fidelity ureteroscopy bench model. Future studies will assess the utility of VR simulators in surgical skills training.
authors.affiliation: Division of Urology, McMaster University, Hamilton, Ontario, Canada. matsumo@mcmaster.ca
authors.forename: Edward D
authors.initials: ED
authors.lastname: Matsumoto
authors.forename: Kenneth T
authors.initials: KT
authors.lastname: Pace
authors.forename: R John
authors.initials: RJ
authors.lastname: D'A Honey
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004867:Equipment Design; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000601:surgery*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D014572:Urology / Q000193:education*; D014584:User-Computer Interface