Surgical teaching of the retropubic midurethral sling: a virtual reality training system

Abstract

Introduction and hypothesis: The objective is to develop a low-risk, cost-effective method to teach procedures that require learning by feel and high-volume pattern recognition, starting with the midurethral sling.

Methods: This video describes the creation of a virtual reality model utilizing de-identified patient data, artificial intelligence algorithms and haptics; and demonstrates the use of the training system for trocar passage of the retropubic midurethral sling procedure.

Results: This innovative system overcomes the lack of visualization and "blind" nature of sling surgery. Novel artificial intelligence provides high accuracy of anatomical landmarks and a realistic 3D environment. The trainee benefits from haptic and visual alerts for real-time feedback on the trocar insertion pathway and scoring to develop competency.

Conclusion: This is one of the first noncadaveric, nonstatic models available in the field. It allows for multiple low-risk exercises and provides more surgeons with training outside the operating room, at their own institution, and avoids the need for patient subjects. Training can be disseminated at a significantly lower cost and greater convenience than remote cadaver laboratories or intraoperative observation and has a higher fidelity than available static models, particularly after multiple passes. This has implications not only for retropubic midurethral slings but also for urogynecological and "blind" surgery as a whole.

Keywords: Haptics; Midurethral sling; Surgical education; Teaching; Virtual reality.