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Face, Content, and Construct Validation of a Novel, Porcine Tissue Simulator for Robotic Assisted Radical Prostatectomy
Andrew Percy, MA1, Mehrdad Alemozaffar, MD2, Ramkishen Narayan, MD1, Brian Minnillo, MD3, Peter Steinberg, MD1, George Haleblian, MD4, Shiva Gautam, PhD1, Kai Matthes, MD PhD1, Andrew Wagner, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2University of Southern California, Los Angeles, CA, USA, 3Children's Hospital Boston, Boston, MA, USA, 4Saint Vincent Hospital, Worcester, MA, USA.

BACKGROUND: There is a paucity of realistic simulators for robotic-assisted radical prostatectomy (RARP). Our goal was to create a novel, high-fidelity, tissue-based simulator that allows practice of key steps of RARP in a sequential fashion.
METHODS: A model was created from female porcine genitourinary tract tissue to represent the urethra, bladder, prostate, pedicles, seminal vesicles, rectum, dorsal venous complex (DVC) and neurovascular bundles. The following steps of RARP were simulated: DVC ligation, division of bladder neck, seminal vesicle dissection, prostatic pedicle ligation with nerve-sparing, urethral division, bladder neck reconstruction, and vesicourethral anastomosis. 10 novices and 10 experts performed RARP on the model and completed a survey. Face validity was calculated by novice ratings of realism and content validity was calculated by experts rating of usefulness of the model as a training tool (based on a 1-5 likert scale, 5=excellent). Construct validity was calculated by comparison of time to complete simulator and rating of performance on the objective structured assessment of technical skill (OSATS) questionnaire (reviewed by non-subject experts on 1-5 likert scale, 5=excellent), between novices and experts.
RESULTS:The model was determined to have good face and content validity with an average score of 3.7/5 and 4.8/5 respectively. The mean time for completion of the simulator was 121.5 mins for the novice and 62 mins for the expert group (p<0.001), and the mean overall OSATS performance ratings were 4.6/5 for experts and 2.6/5 for novices (p<0.001), yielding good construct validity.
CONCLUSIONS: We created and validated a realistic, tissue-based simulator to allow for training of key surgical steps of RARP in a sequential fashion. Ultimately, this simulator could be incorporated into urology residency/fellowship training, hospital credentialing, and/or facilitate surgeons transitioning from open prostatectomy to RARP.


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