Transurethral Resection of Bladder Tumors: Next-generation Virtual Reality Training for Surgeons

Background: The number of virtual reality (VR) simulators is increasing. The aim of this prospective trial was to determine the benefit of VR cystoscopy (UC) and transurethral bladder tumor resection (TURBT) training in students. Design, setting, and participants: Medical students without endoscopic experience (n = 51, median age = 25 yr, median 4th academic year) were prospectively randomized into groups A and B. After an initial VR-UC and VR-TURBT task, group A (n = 25) underwent a video-based tutorial by a skilled expert. Group B (n = 26) was trained using a VR training program (Uro-Trainer). Following the training, every participant performed a final VR-UC and VR-TURBT task. Performance indicators were recorded via the simulator. Data was analyzed by Mann-Whitney U test. Intervention: VR cystoscopy and TURBT. Results and limitations: No baseline and post-training differences were found for VR-UC between groups. During baseline, VR-TURBT group A showed higher inspected bladder surface than group B (56% vs 73%, p = 0.03). Subgroup analysis detected differences related to sex before training (male: 31.2% decreased procedure time; 38.1% decreased resectoscope movement; p = 0.02). After training, significant differences in procedure time (3.9 min vs 2.7 min, p = 0.007), resectoscope movement (857 mm vs 529 mm, p = 0.005), and accidental bladder injury (n = 3.0 vs n = 0.88, p = 0.003) were found. Male participants showed reduced blood loss (males: 3.92 ml vs females: 10.12 ml; p = 0.03) after training. Conclusions: Measuring endoscopic skills within a virtual environment can be done easily. Short training improved efficacy and safety of VR-TURBT. Nevertheless, transfer of improved VR performance into real world surgery needs further clarification. Patient summary: We investigated how students without endoscopic experience profit from simulation-based training. The safe environment and repeated simulations can improve the surgical training. It may be possible to enhance patient's safety and the training of surgeons in long term. Simulator training teaches endourological interventions under controlled conditions. Students without endoscopic experience profit from simulation-based training. In conclusion, a simulation-based training is very useful to push the surgical learning curve of future urologist 2.0.