4 61categories based upon robotic surgery experience. The authors found that the experts
gave the simulation a median score of 8/10 in terms of realism (face validity). Experts
also rated the platform highly in terms of its ability to teach relevant anatomy (9/10)
and operative steps (8.5/10), suggesting content validity. Construct validity was sug-
gested with experts performing significantly better than both novices and intermedi-
ates in a number of categories. Interestingly, the authors had the participants perform
an in vivo porcine partial nephrectomy and found performance on the simulator cor-
related strongly with performance in the porcine partial nephrectomy (r = 0.8,
p < 0.0001), demonstrating concurrent validity [ 80 ].
Bladder/Ureter
As with kidney simulation, there is currently little availability in the way of bladder-
and ureter-specific robotic simulators. This may be a consequence of the relatively
recent move toward doing more bladder/ureter procedures in a robotic fashion.
Hung et al. have published a relatively simple cystotomy repair simulation in which
a 2.5 cm incision is made on the anterior surface of a porcine bladder and a water-
tight closure is made using a robot [ 71 ].
Ureteral reimplantation represents a growing field in minimally invasive surgery,
as minimally invasive techniques have been shown to have similar functional out-
comes similar to those of open procedures [ 81 , 82 ]. Despite its increased prevalence,
ureteral reimplantation remains a relatively infrequently done procedure that may be
lacking in traditional urologic training, particularly those done in a minimally invasive
Fig. 24.9 Fundamentals of Robotic Surgery Dome for acquisition of basic robotic skills [ 20 ]
24 Simulation in Surgery