Current Status of Simulation and Training Models in Urological Surgery: A Systematic Review

Purpose: Increased awareness of patient safety, advances in surgical technology and reduced working times have led to the adoption of simulation enhanced training. However, the simulators available need to be scientifically evaluated before integration into curricula. We identify the currently available training models for urological surgery, their status of validation and the evidence behind each model. Materials and Methods: MEDLINE (R), Embase (R) and the Cochrane Library databases were searched for English language articles published between 1990 and 2015 describing urological simulators and/or validation studies of these models. All studies were assessed for level of evidence, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education by the European Association of Endoscopic Surgeons. Results: A total of 91 validation studies were identified pertaining to training models in endourology (63), laparoscopic surgery (17), robot- assisted surgery (8) and open urological surgery (6), with a total of 55 models. Of the included studies 6 were classified Level 1b, 9 Level 2a, 39 Level 2b and 19 Level 2c. Of all the training models the URO Mentor (R) was the only one to receive a level of recommendation of 1. Conclusions: UroSimulation is a growing field and increasing numbers of models are being produced. However, there are still too few validation studies with a high level of evidence demonstrating the transferability of skills. Nevertheless, efforts should be made to use the currently available models in curriculum based training programs.