© 2010 THE AUTHORS BJU INTERNATIONAL © 2 0 1 0 B J U I N T E R N A T I O N A L | 1 0 6 , 1 7 5 3 – 1 7 5 6 | doi:10.1111/j.1464-410X.2010.09753.x 1753 2010 THE AUTHORS; BJU INTERNATIONAL 2010 BJU INTERNATIONAL Laparoscopic and Robotic Urology PERCUTANEOUS RENAL ACCESS TRAINING DESAI ET AL. Percutaneous renal access training: content validation comparison between a live porcine and a virtual reality (VR) simulation model Shashikant Mishra, Abraham Kurien, Arvind Ganpule, Veeramani Muthu, Ravindra Sabnis and Mahesh Desai Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India Accepted for publication 29 January 2010 flouroscopic guidance using a 22-G ‘skinny’ needle (Cook Medical, Bloomington, IN, USA). • Then the specific task of PRA using a similar case scenario was done using the PERC Mentor. • The experts rated the models using a questionnaire based on a 5-point Likert scale, consisting of 10- and three-items of realism and usefulness, respectively. RESULTS • Of the 10 items of realism assessed, the porcine model was rated as better than the PERC Mentor for ‘overall realism’, ‘movement of the kidney’, ‘tactile feedback of perinephric space’, ‘fluoroscopic realism’ and ‘complications encountered’ (All P < 0.001). • It was inferior to the PERC Mentor for ‘orientation to the flank’, ‘aspiration’, ‘repetitive performance’ and ‘organisational feasibility’ (All P < 0.001). • ‘Tactile feedback of successful access’ was similar in both models (mean [SD] points, 4.24 [0.7] vs 4.6 [0.5]). • Of the three items of usefulness, ‘overall usefulness’ (4.6 [0.6] vs 4.65 [0.5]) and ‘use as a training tool’ (4.32 [0.5] vs 4.75 [0.4]) was similar; however, the porcine model was a much better assessment tool (P < 0.001). CONCLUSIONS • Both models have relative advantages and disadvantages. The live porcine model is a more realistic assessment tool for PRA. The specific advantage of the PERC Mentor is of repetitive tasking and easier set up feasibility. • The overall usefulness was same for both the models. KEYWORDS percutaneous renal access training, PERC Mentor, live porcine model Study Type – Operational research (education) content analysis Level of Evidence 3b OBJECTIVE • To compare the content validity (realism and usefulness) of percutaneous renal access (PRA) obtained on a live porcine model and a high-fidelity computer-based surgical simulator (PERC Mentor, Simbionix; Lod, Israel) in our skills laboratory for trainees interested in PRA training, so as to determine which of the two is a more appropriate and effective training model. MATERIALS AND METHODS • In all, 24 ‘experts’ performed PRA in a live porcine model and using the PERC Mentor. • The porcine model access required a live anaesthetized pig with a pre-placed ureteric catheter. The access was done with INTRODUCTION Various models have been described for use in percutaneous renal access (PRA) training [1]. These include low-fidelity bench models, high-fidelity computer-based bench simulation models, ex vivo dead animal models and live in vivo animal models [2–4]. The appropriate usefulness of these models has been studied individually. There are no publications that directly compare these models. In the surgical skills laboratory of our institute, we incorporated a live porcine model and a high-fidelity simulation model for trainees interested in PRA. The purpose of the present study was to evaluate as to which model was more appropriate for PRA training. MATERIALS AND METHODS The study was conducted in the Surgical Skills Laboratory, Muljibhai Patel Urological Hospital, India. The participants included were ‘experts’ who performed the PRA in both the models. ‘Expert’ was defined as a participant that had done >50 cases of percutaneous nephrolithotomy (PCNL). In all, 24 experts including participants of a PCNL workshop and institute consultants were included in the study. A live anaesthetized pig for the animal model (Group 1) and the PERC Mentor (Simbionix; Lod, Israel) for the high-fidelity computer- based surgical simulator model (Group 2) were used for the study. The participants first performed PRA in the porcine model. Success was defined as achieving PRA without the passage of a guidewire. After appropriate anaesthesia, before PRA, the pig underwent bilateral ureteric catheterization for opacification of the collecting system. The pig was then placed prone (Fig. 1) on a specially designed couch to accommodate the bend of the C-arm. With the use of a real-time C-arm, and as and when required contrast study for delineation of pelvicalyceal anatomy, an BJUI BJU INTERNATIONAL