470
the technique [ 125 ]. Consequently, a bench-top model has been created to address
this steep learning curve.
Developed by Kinoshita et al. and referred to as the Kansai Medical University
HoLEP bench model [ 126 ], it contains a prostatic hyperplasia model that can be
installed into a box simulator along with standard cystoscopic equipment and hol-
mium lasers used to enucleate the model. Additionally, trainees are responsible for
real-time fluid management to complete the procedure. The Kansai Medical
University HoLEP bench model demonstrated face and content validity in a study
of 36 participants by Aydin et al. [ 127 ].
There is a virtual reality simulator, the UroSim HoLEP simulator (VitraMed,
Zurich, Switzerland), that has been developed and uses a cystoscope module con-
nected to a computer system to simulate the procedure (Fig. 24.11). The simulator
is equipped with haptic feedback and six different operative cases with varying
anatomical variations and degrees of prostatic hyperplasia. In a study of 53 partici-
pants, Kuronen-Stewart et al. divided participants into three groups—novices, inter-
mediate, and experts. The investigators were able to demonstrated face, content, and
construct validity with significant differences in the enucleation efficiency, mea-
sured as grams enucleated per hour, between each group and a realism score of 5.6
out of 10 among experts [ 128 ].
Transrectal Ultrasound (TRUS) Prostate Biopsy
The TRUS-guided prostate biopsy currently is the gold standard to histologically
diagnose prostate cancer. However, this relatively simple procedure is not without
risk, with 0.69% of men requiring hospitalization to treat complications and reported
mortality rates of 1.3% at 120 days [ 129 , 130 ]. As such, there is a demand to develop
simulators that could help bypass the early learning curve of the procedure and help
avoid errors made in human patients. This is especially important given the more
Fig. 24.11 Robotic-assisted partial nephrectomy foam ball excision operative view [ 79 ]
W. Baas et al.