Holmium Laser Enucleation of the Prostate: Simulation-Based Training Curriculum and Validation

OBJECTIVE: To evaluate the face, content, and construct validity of a novel virtual reality simulator for holmium laser enucleation of the prostate (HoLEP) and also assess its feasibility and acceptability as a training model.

METHODS: This prospective observational study recruited 53 participants, comprising of 3 groups: HoLEP Experts (n=11), Intermediates (n=24), and Novices (n=18). All participants received an educational package and a 15-minute familiarisation exercise with the simulator. All participants then carried out a full enucleation on an identical 60cc virtual prostate. Performance was assessed using in-built simulator metrics, and a questionnaire was distributed assessing face and content validity, as well as feasibility, and acceptability. Novice, intermediate, and expert groups were compared using the Mann-Whitney U test.

RESULTS: Construct validity data revealed significant differences in enucleation efficiency (Grams enucleated per hour) when comparing experts to intermediates (p=0.003), experts to novices (p<0.001) and intermediates to novices (p=0.001). Face Validity was rated by experts as acceptable, with a mean score of 5.6 out of 10 when asked to rate the overall realism. Content validity questions showed 85% of participants agreed that simulator-based assessment is essential for patient safety and 87% agreed that there was a role for a validated VR simulator for use in HoLEP training.

CONCLUSIONS: This study established face, content and construct validity for this novel virtual reality HoLEP simulator. The majority of participants also thought that it is a feasible and acceptable model for HoLEP training.