Simulation-based training in minimally invasive partial nephrectomy

Minimally-invasive partial nephrectomy (MIPN) is the standard treatment for kidney tumors with a diameter smaller than 4 cm. It is also performed in selected cases of tumors reaching 7 cm, but it may lead to potential complications. We investigated the current literature for simulators that could be used to teach urologists alone or within the boundaries of a course or a curriculum.

We performed a literature search using PubMed (Ovid Medline Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE [R] Daily, and Ovid MEDLINE [R]). Search terms included: simulation, simulation training, education, curricul*, partial nephrectomy, and nephron-sparing surgery. The primary endpoints were the efficacy of different simulators and the impact of different devices, curricula, or courses in training and trainee learning curves.

We identified 16 studies evaluating simulation with 3D reconstruction, ex vivo, in vivo, synthetic models, and virtual reality simulators. Additionally, we identified one study presenting a training curriculum. The results appeared promising, although currently available studies are scarce. Regardless of the type of simulator, participants stated that, to some degree, their skills were improved and their confidence was elevated.

Simulation-based training can help novice surgeons familiarize themselves with complex procedure steps and reduce learning curves. A specific validated curriculum for this operation still needs to be included. Validating simulators or curricula for MIPN could be essential to enable more urologists to treat patients safely and effectively.