title: Validation of virtual reality simulation for percutaneous renal access training.
abstract: OBJECTIVE
  The objective of this study was to assess the face, content, construct, convergent, and predictive validities of virtual reality-based simulator in acquisition of skills for percutaneous renal access.
  
  
  METHODS
  A cohort of 24 participants comprising novices (n = 15) and experts (n = 9) performed a specific task of percutaneous renal puncture using the same case scenario on PERC Mentor. All objective parameters were stored and analyzed to establish construct validity. Face and content validities were assessed by having all experts fill a standardized questionnaire. All novices underwent further repetition of the same task six times. The first three were unsupervised (pretest) and the later three after the PERC Mentor training (posttest) to establish convergent validity. A subset of five novice cohorts performed percutaneous renal access in an anesthetized pig before and after the training on PERC Mentor to assess the predictive validity. Statistical analysis was done using Student's t-test (p <or= 0.05 statistically significant).
  
  
  RESULTS
  The overall useful appraisal was 4 in a scale of 1 to 5 (1 is poor and 5 is excellent). Experts were significantly faster in total performance time 187 +/- 26 versus 222 +/- 29.6 seconds (p < 0.005) and required fewer attempts to access 2.00 +/- 0.20 versus 2.8 +/- 0.4 (p < 0.001), respectively. The posttest values for the trained novice group showed marked improvement with respect to pretest values in total performance time 42.7 +/- 6.8 versus 222 +/- 29.6 seconds (p < 0.001), fluoroscopy time 66.9 +/- 10.20 versus 123.3 +/- 19.40 seconds (p < 0.0001), decreasing number of perforation 0.8 +/- 0.3 versus 1.3 +/- 0.2 (p < 0.001), and number of attempts to access 1.3 +/- 0.10 versus 2.00 +/- 0.20 (p < 0.001), respectively. Access without complication was attained by all five when compared with one with three complications (baseline vs. posttraining group, respectively) in the porcine model.
  
  
  CONCLUSIONS
  All aspects of validity were demonstrated on virtual reality-based simulator for percutaneous renal access.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
authors.forename: Shashikant
authors.initials: S
authors.lastname: Mishra
authors.forename: Abraham
authors.initials: A
authors.lastname: Kurien
authors.forename: Rajesh
authors.initials: R
authors.lastname: Patel
authors.forename: Pradip
authors.initials: P
authors.lastname: Patil
authors.forename: Arvind
authors.initials: A
authors.lastname: Ganpule
authors.forename: Veeramani
authors.initials: V
authors.lastname: Muthu
authors.forename: Ravindra B
authors.initials: RB
authors.lastname: Sabnis
authors.forename: Mahesh
authors.initials: M
authors.lastname: Desai
mesh_terms: D000818:Animals; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D015203:Reproducibility of Results; D034421:Sus scrofa / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000193:education*; D014584:User-Computer Interface