Validation of Virtual Reality Simulation for Percutaneous Renal Access Training

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. Materials and 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(TM). 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 <= 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. Conclusion: All aspects of validity were demonstrated on virtual reality-based simulator for percutaneous renal access.