Virtual reality simulator for training urologists on transurethral prostatectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields. They can simulate a variety of surgical scenarios to improve the overall skills required for endoscopic operations, and also record the operative process of trainees in real-time and allow for objective evaluation. At present, some simulators for transurethral resection of the prostate (TURP) are available. The utility of virtual reality simulators in training of transurethral prostatectomy was investigated.</p><p><b>METHODS</b>Thirty-eight urologists were randomly selected to take part in a simulation based training of TURP using the TURPSim(TM) system. Pre and post-training global rate scale (GRS) scores and objective parameters recorded by the simulator were assessed. Then, questionnaires were filled out.</p><p><b>RESULTS</b>Compared with baseline levels, the GRS scores of trainees increased (18.0 ± 4.0 vs. 12.4 ± 4.2, P < 0.001), while the rate of capsule resection (26.3% ± 0.6% vs. 21.2% ± 0.4%, P < 0.001), amount of blood loss ((125.8 ± 86.3) ml vs. (83.7 ± 41.6) ml, P < 0.001), external sphincter injury (3.6 ± 2.9 vs. 2.0 ± 2.0, P < 0.001) decreased significantly after training. Most trainees were satisfied with the simulator based training and believed that the simulator accurately mimicked actual surgical procedures and could help improve their surgical skills.</p><p><b>CONCLUSIONS</b>As a new method of training on transurethral prostatectomy skills, training of TURP using a virtual simulator can help urologists improve their surgical skills and safety. Therefore, the application of the TURPSim(TM) system in education and training of urologic surgery is warranted.</p>

Training for percutaneous renal access on a virtual reality simulator / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC Mentor(TM) is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training.</p><p><b>METHODS</b>Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC Mentor(TM) after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt.</p><p><b>RESULTS</b>During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P = 0.03 and 0.02, respectively).</p><p><b>CONCLUSIONS</b>The training on the virtual reality simulator, PERC Mentor(TM), can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in teaching fluoroscopy-guided percutaneous renal access.</p>

Effectiveness of the UroMentor virtual reality simulator in the skill acquisition of flexible cystoscopy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Virtual reality (VR) has been recognized as a useful modality in the training of surgical skills. With respect to basic endoscopic skill training of urology, we sought to investigate the effectiveness of the UroMentor(TM) virtual reality simulator (VRS) in the skill acquisition of flexible cystoscopy.</p><p><b>METHODS</b>Urologists familiar with rigid cystoscopy procedures were selected to take part in a virtual training course of flexible cystoscopy. Changes in total operating time, frequency of injury, number of digital markers inside the bladder, and the global rating scale (GRS) scores were assessed following eight repeated training sessions on the UroMentor(TM).</p><p><b>RESULTS</b>Eighteen urologists voluntarily took part in the study. Total operating time was significantly lower after eight sessions of training by comparison ((111 ± 10) seconds and (511 ± 67) seconds, respectively; P < 0.001). Additionally, the frequency of injury decreased with training from (12 ± 2) times to (5 ± 1) times (P < 0.001), while the number of digital markers observed increased from 9 ± 0 to 10 ± 1 (P = 0.005). Finally, training with the UroMentor(TM) resulted in a GRS increase from (1.3 ± 0.2) points to (3.9 ± 0.2) points (P < 0.001).</p><p><b>CONCLUSION</b>the VRS UroMentor(TM) can improve urologists' ability to perform flexible cystoscopy and could be used as an effective training tool for trainees.</p>

Face and content validation of the virtual reality transurethral prostatic resection simulator / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the face and content validation of the virtual reality transurethral resection of the prostate simulator (TURPSim(TM)).</p><p><b>METHODS</b>The 60 urology doctor aged 26 - 50 years old all over the country were enrolled for virtual reality training of TURP from September 2010 to June 2011. Participants classified as experts (more than 50 procedures performed) and novices (50 or fewer procedures performed) performed TURPs on TURPSim(TM) involving resection of 25 - 80 g prostate. They completed questionnaires regarding utility for residency training, realism and overall score of the TURPSim(TM). Performances of two groups were evaluated after 2-day training.</p><p><b>RESULTS</b>were recorded and analyzed.</p><p><b>RESULTS</b>Mean utility for residency training, realism and overall score were (8.8 ± 1.1) and (8.5 ± 1.4), (8.0 ± 1.2) and (8.4 ± 1.1), (8.7 ± 0.9) and (8.6 ± 0.8) in experts and novices respectively. There was no significant difference between two groups (P > 0.05). Spearman's correlation coefficients analysis showed an significant positive correlation between utility for residency training and realism (r = 0.625, P = 0.000), utility for residency training and overall score (r = 0.691, P = 0.000) in experts, utility for residency training and realism (r = 0.702, P = 0.000), utility for residency training and overall score (r = 0.664, P = 0.001) in novices. Prostate resection rate (87.3% ± 7.7%), bleeding control rate (94.4% ± 6.6%) and safety (95.2% ± 5.5%) in novices increased after training (t = -3.689, -2.274, -2.507, all P < 0.05).</p><p><b>CONCLUSIONS</b>The face and content validation of transurethral resection of the prostate simulator is good, virtual reality training of TURP may improve the skills necessary to perform TURP. Transurethral resection of the prostate simulator can be used to train urology residents.</p>

Effects of urotensin II on isolated rat hearts under normal perfusion and ischemia reperfusion / 生理学报

To shed light on cardiac effects of the potent vasoconstrictive peptide urotensin II (U II), Langendorff-perfused isolated rat hearts were consecutively perfused with 0.1, 1 and 10 nmol/L U II, for 5 min at each dose, followed by 5-min washout. Moreover, isolated hearts subjected to 20-min global no-flow ischemia were reperfused with U II (1 or 10 nmol/L) for 20 min. Heart function parameters including heart rate, left ventricular pressure and dP/dt were monitored; content of protein and myoglobin, and activity of lactate dehydrogenase (LDH) in coronary effluent were determined; malondialdehyde (MDA) in myocardium and [(125)I]-U II binding sites in plasma membrane were measured after the completion of perfusion. The results showed that: (1) In normal rat hearts, the coronary flow was decreased and the heart function was suppressed by U II dose-dependently, and these changes were not abolished by washout. The leakage of cardiac protein, myoglobin and LDH increased with the increment of U II, but it diminished rapidly after washout. In contrast, MDA content in U II -treated myocardium was not statistically different from that in normal myocardium. (2) Ischemia-reperfusion caused significant decreases in coronary flow, suppression of heart function, and leakage of protein and LDH. In U II -reperfused hearts, all these disorders were significantly aggravated and myocardial MDA content significantly increased (P<0.01), to a greater extent in the presence of higher dose of U II. (3) The maximal binding capacity (B(max)) of U II receptors in plasma membrane from ischemia-reperfusion myocardium increased significantly as compared with that of normal myocardium (20.53+/-1.98 vs 14.65+/-1.78 fmol/mg pr, P<0.01), while Kd remained unchanged. These results indicate that U II caused injury to the isolated rat hearts under normal perfusion, and worsened the injury of the hearts under ischemia-reperfusion, in which U II receptors were up-regulated.