Surgical teaching of the retropubic midurethral sling: a virtual reality training system

Introduction and hypothesisThe objective is to develop a low-risk, cost-effective method to teach procedures that require learning by feel and high-volume pattern recognition, starting with the midurethral sling.MethodsThis video describes the creation of a virtual reality model utilizing de-identified patient data, artificial intelligence algorithms and haptics; and demonstrates the use of the training system for trocar passage of the retropubic midurethral sling procedure.ResultsThis innovative system overcomes the lack of visualization and "blind" nature of sling surgery. Novel artificial intelligence provides high accuracy of anatomical landmarks and a realistic 3D environment. The trainee benefits from haptic and visual alerts for real-time feedback on the trocar insertion pathway and scoring to develop competency.ConclusionThis is one of the first noncadaveric, nonstatic models available in the field. It allows for multiple low-risk exercises and provides more surgeons with training outside the operating room, at their own institution, and avoids the need for patient subjects. Training can be disseminated at a significantly lower cost and greater convenience than remote cadaver laboratories or intraoperative observation and has a higher fidelity than available static models, particularly after multiple passes. This has implications not only for retropubic midurethral slings but also for urogynecological and "blind" surgery as a whole.