Alexander Beulens

66 Chapter 3 pleted their informed consent form. After this the participants attended the presentation (lecture) on the simulator, the simulation exercises and the anatomy of the pelvic region. The participants had 30 minutes for the basic simulation training and the following exercises were practiced during this time at least once per person: • Camera 0 (figure 3A): camera control training • Wristed manipulation 1 (figure 3B): Endowrist manipulation training • Wristed manipulation 2 (figure 3C): camera control and Endowrist manipulation training • Knot tying (figure 3D): surgical knot tying training • Railroad track (figure 3E): suturing training After completing these exercises, the participants were asked to train autonomously the vesicourethral anastomosis exercise on the simulator for 30 minutes (pre-intervention phase) (figure 3f). During this phase no additional explanation was provided by the trainers and after 30 minutes the training was interrupted also in the case of non-completion of the exercise. After this initial attempt all groups received a total of 30 minutes to train on the vesicourethral anastomosis exercise under different or no guidance according to the assigned group. In all cases, the participants received the standard automated feedback from the simulator. The first group was the proctor guided group, this group performed the vesicourethral anastomosis exercise under the guidance of a trainer (proctor) (figure 3F). The proctor provided the participants guidance by monitoring the real-life progress of the participants on a nearby screen and gave in-time oral feedback during the procedure. Tips and tricks were provided by the proctor on how to avoid tissue damage and how to safely perform the surgical steps. The second group is the simulator-generated guidance group, this group performed the vesicourethral anastomosis exercise under the guidance of the simulator (figure 3G). The simulator provided them with pre-programmed guided feedback which mainly helped participants with correct needle placement and the use of appropriate force during stitching and tissue handling. Guidance was automatically disabled when the participant repeatedly ignored the simulator’s guidance. In this case the participants had to complete the procedure without guidance. The participants were informed about this feature by the researchers at the start of the training.