Place of the Simulation in the Learning of Hemostasis During Endoscopic Resection of Prostate: Senegalese Experience

Endoscopic resection, whether mono or bipolar, remains the endo-urological reference technique for the treatment of benign prostate hypertrophy in Sub-Saharan Africa. A high number of procedures is necessary when training a resident to master this technique. Controlling hemostasis is one of the most important issues in learning this surgical procedure. The reduction of companionship time on the operating theatre and the high number of urology residents at the University of Dakar constitute an obstacle to learning this technique leading to the use of new methods of Training. Various studies have evaluated the interest of simulation for training in endoscopic prostate resection. It is part of the educational program of some universities, particularly the Anglo-Saxons. The authors report their experience on the TurPsim simulator of the STORZ Company (Virtamed AG, Zurich, Switzerland). 43 participants were evaluated on a basic hemostasis control exercise with the goal of achieving a minimum of 17 hemostasis within a specified time. 31 of them, also performed the resection of a small-volume prostate to assess the importance of bleeding during this endoscopic procedure. 30 residents and 13 certified urologists including three expert trainers participated in this study. The survey of participants confirms the benefit of the simulation, allowing the multiplication of procedures in order to get a critical analysis before permitting a resident access to the operating theatre, thus simplifying the curve learning. In the light of this experience, a real educational program including simulation, can be considered in expert training centers as in Senegal. Simulation is becoming increasingly important in some universities which integrate it into the training courses. The currently validated virtual reality simulators meet educational objectives, although their use for the learning of endoscopic resection should be encouraged.