title: Simulation-based training for prostate surgery.
abstract: OBJECTIVE
  To identify and review the currently available simulators for prostate surgery and to explore the evidence supporting their validity for training purposes.
  
  
  METHODS
  A review of the literature between 1999 and 2014 was performed. The search terms included a combination of urology, prostate surgery, robotic prostatectomy, laparoscopic prostatectomy, transurethral resection of the prostate (TURP), simulation, virtual reality, animal model, human cadavers, training, assessment, technical skills, validation and learning curves. Furthermore, relevant abstracts from the American Urological Association, European Association of Urology, British Association of Urological Surgeons and World Congress of Endourology meetings, between 1999 and 2013, were included. Only studies related to prostate surgery simulators were included; studies regarding other urological simulators were excluded.
  
  
  RESULTS
  A total of 22 studies that carried out a validation study were identified. Five validated models and/or simulators were identified for TURP, one for photoselective vaporisation of the prostate, two for holmium enucleation of the prostate, three for laparoscopic radical prostatectomy (LRP) and four for robot-assisted surgery. Of the TURP simulators, all five have demonstrated content validity, three face validity and four construct validity. The GreenLight laser simulator has demonstrated face, content and construct validities. The Kansai HoLEP Simulator has demonstrated face and content validity whilst the UroSim HoLEP Simulator has demonstrated face, content and construct validity. All three animal models for LRP have been shown to have construct validity whilst the chicken skin model was also content valid. Only two robotic simulators were identified with relevance to robot-assisted laparoscopic prostatectomy, both of which demonstrated construct validity.
  
  
  CONCLUSIONS
  A wide range of different simulators are available for prostate surgery, including synthetic bench models, virtual-reality platforms, animal models, human cadavers, distributed simulation and advanced training programmes and modules. The currently validated simulators can be used by healthcare organisations to provide supplementary training sessions for trainee surgeons. Further research should be conducted to validate simulated environments, to determine which simulators have greater efficacy than others and to assess the cost-effectiveness of the simulators and the transferability of skills learnt. With surgeons investigating new possibilities for easily reproducible and valid methods of training, simulation offers great scope for implementation alongside traditional methods of training.
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, King's Health Partners, London, UK.
authors.forename: Raheej
authors.initials: R
authors.lastname: Khan
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, King's Health Partners, London, UK.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Aydin
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, King's Health Partners, London, UK.
authors.forename: Muhammad Shamim
authors.initials: MS
authors.lastname: Khan
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, King's Health Partners, London, UK.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, King's Health Partners, London, UK.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
mesh_terms: D000818:Animals; D004285:Dogs; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education; D008297:Male; D008954:Models, Biological; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000193:education*; D065287:Robotic Surgical Procedures / Q000193:education*; D066231:Surgeons / Q000193:education*; D014584:User-Computer Interface
keywords: assessment; prostate; simulation; training