Objective:

We assessed the construct validity of the LapSim laparoscopic surgical simulator in a urology residency training program.

Methods:

In total, 15 residents participated in the study between July 2007 and July 2008. The subjects were tested six times at one-month intervals on three skill tasks (lifting and grasping, cutting and clip application) using the LapSim laparoscopic simulator. The testing sessions were divided into the first three sessions (seminar 1), and the subsequent three sessions (seminar 2). We evaluated the following parameters: total time, path length, angular path length, tissue damage, maximum damage and stretch damage. The subjects were divided into junior (PGY 1,2) and senior resident groups (PGY 3,4,5). The Wilcoxon Signed-Rank test for paired samples was used to compare the performances of the juniors and seniors during seminar 1 to their performance in seminar 2 to determine whether there was improvement over time. The Wilcoxon Rank-Sum test for independent samples was used to compare the performance of the juniors to that of the seniors for seminar 1, seminar 2 and the combination of both seminars to determine whether the more experienced senior residents performed better than the less experienced juniors.

Results:

No significant performance improvement between testing sessions could be demonstrated. Similarly, there was no significant difference in performance between junior and senior residents.

Conclusions:

Construct validity could not be demonstrated for the total time, path length, angular path length and tissue handling parameters of the LapSim laparoscopic surgical simulator when examined within the context of a urology residency program.

Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously.