Construct Validity of a Full Procedure, Virtual Reality, Real-Time, Simulation Model for Training in Transurethral Resection of the Prostate

Purpose: To examine the content and construct validity of a full procedure transurethral prostate resection simulation model (PelvicVision). Materials and Methods: The full procedure simulator consisted of a modified resectoscope connected to a robotic arm with haptic feedback, foot pedals, and a standard desktop computer. The simulation calculated the flow of irrigation fluid, the amount of bleeding, the corresponding blood fog, the resectoscope movements, resection volumes, use of current, and blood loss. Eleven medical students and nine clinically experienced urologists filled in questionnaires regarding previous experiences, performance evaluation, and their opinion of the usefulness of the simulator after performing six ( students) and three ( urologists) full procedures with different levels of difficulty. Their performance was evaluated using a checklist. Results: The urologists finished the procedures in half the time as the students with the same resection volume and blood loss but with fewer serious perforations of the prostatic capsule and/or sphincter area and less irrigation fluid uptake. The resectoscope tip movement was longer and the irrigation fluid uptake per resected volume was about 5 times higher for the students. The students showed a positive learning curve in most variables. Conclusion: There is proof of construct validity and good content validation for this full procedure simulator for training in transurethral resection of the prostate. The simulator could be used in the early training of urology residents without risk of negative outcome.