Implementation and Validation of a High-fidelity Simulation Model for Surgical Resident Training: Management of Acute Intraoperative Hemorrhage during Robot-assisted Surgery

Michael Kheshvadjian, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; George Washington University School of Medicine, Washington, DC. Electronic address: michaelkhesh@gmail.com.
Michael Nazmifar, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Rushil Rawal, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Joshua Davood, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Peris Castaneda, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Eman Dadashian, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Jeremiah Dallmer, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
John Heard, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
John Masterson, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Eric Lo, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Lior Taich, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Aurash Naser-Tavakolian, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Paul Kokorowski, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Michael Ahdoot, Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

Document Type

Journal Article

Publication Date

9-1-2024

Journal

Urology

Volume

191

DOI

10.1016/j.urology.2024.06.055

Abstract

OBJECTIVE: To improve our previous simulation-based training module by using sustainable material to mold an anatomically accurate terrain and reproducing major vascular injuries encountered during robot-assisted nephrectomy. METHODS: The simulator was built with a pump, gauge, and valve linked via silicone tubing. Artificial blood was made from cornstarch, water, and red dye, and pumped through 3D-Med artificial vessels with the dimensions of an average renal artery. Silicone was used to emulate the pliability of organic tissue and mold an anatomically accurate terrain. Eight urologic residents participated in the pilot simulation. We employed validated assessment tools including Non-Technical Skills for Surgeons and Objective Structured Assessment of Technical Skills forms to guide debrief sessions moderated by an expert physician after individual performance evaluations. RESULTS: The apparatus demonstrated high reproducibility across all simulation scenarios, enhancing resident problem-solving skills. Residents' pre-simulation surveys revealed significant concern regarding their acute hemorrhage management. Residents' post-simulation survey demonstrated average realism scores increased from 4.375 to 4.75. Residents also felt the simulator enhanced learning, offering valuable practice and knowledge applicable to their surgical specialty. CONCLUSION: The management of acute hemorrhage during robot-assisted surgery remains a space for additional surgical education and training. Our simulation successfully provided a reliable, reproducible training for residents to practice their technical and non-technical skills in managing acute hemorrhage.

Department

School of Medicine and Health Sciences Student Works

Link to Full Text

Share

COinS