Simulation-Based Cryosurgery Training: Variable Insertion Depth Planning in Prostate Cryosurgery

A proof-of-concept for an advanced-level computerized training tool for cryosurgery is demonstrated, based on three-dimensional cryosurgery simulations and a variable insertion depth strategy for cryoprobes. The objective for system development is two-fold: to identify a cryoprobe layout in order to best match a planning isotherm with the target region shape and to verify that cryoprobe placement does not violate accepted geometric constraints. System validation has been performed by collecting training data from 17 surgical residents having no prior experience or advanced knowledge of cryosurgery. This advanced-level study includes an improved training session design in order to enhance knowledge dissemination and elevate participant motivation to excel. In terms of match between a planning isotherm and the target region shape, results of this demonstrate trainee performance improvement from 4.4% in a pretest to 44.4% in a posttest over a course of 50 minutes of training. In terms of combined performance, including the above-mentioned geometrical match and constraints on cryoprobe placement, this study demonstrates trainee performance improvement from 2.2% in the pretest to 31.1% in the posttest. Given the relatively short training session and the lack of prior knowledge, these improvements are significant and encouraging. These results are of particular significance, as they have been obtained from a surgical resident population which are exposed to the typical stress and constraints in advanced surgical education.