Assessing spatial perception of learners during holmium laser enucleation of the prostate (HoLEP).

Background: Holmium laser enucleation of the prostate (HoLEP) has a steep learning curve. Specific educational efforts to improve HoLEP training has not been extensively studied. The aim of this study was to assess the spatial perception of urology residents (learners) HoLEP videos to improve future educational efforts. Methods: A cross-sectional simulation-based observational study during an academic urology conference was performed. A HoLEP recording was shown to resident physicians and paused at 5 time points. Resident physicians were then asked to mark down coordinates on diagrams of prostates in the coronal, axial and sagittal dimensions at each pause to denote where they perceived the laser was pointing. Results: Twenty-one urology residents (learners) participated in the study, of whom, 47.6% had prior HoLEP exposure. The learners plotted perceived coordinates at pre-designated time points in 3 dimensions throughout a HoLEP, totaling 315 coordinates. Learners perceived more accurately in the coronal dimension and were most accurate in identifying the verumontanum (the first time point of the procedure). Those with prior HoLEP exposure, as well as senior residents, were significantly more likely to accurately pinpoint the verumontanum in the coronal dimension (P=0.04, 0.03 respectively). Prior HoLEP exposure and post-graduate year (PGY)-level was not associated with accurately identifying the other time points in all dimensions. Conclusions: Spatial understanding during a HoLEP is challenging and learners are inaccurate in pinpointing coordinates while watching endoscopic recordings alone, regardless of PGY-level and prior HoLEP exposure. Learners appear to perceive in the coronal dimension more accurately as opposed to the axial or sagittal dimensions. This could be used to direct future educational efforts for teaching HoLEP.