Service & supportLog in to Connect
  • Custom solutions
Contact usBook a demo
Contact us
Custom solutionsLog in to Connect
Book a demo

Stay informed

Get insights about data-driven medical education and simulation news delivered to your inbox. No spam, ever!

Follow us

Contact us

info@virtamed.com

+41 44 500 96 90 (International)

+1 844 746 4357 (Americas)

Clinical

Clinical evidencePatent list

About

Where to find usCareer

VirtaMed believes that all patients should experience surgical excellence. Since 2007, we empower surgeons and medical staff to reach proficiency by integrating intelligent simulation into medical education.

© 2026 VirtaMed AG

Privacy & cookie policy

Content hub

Development and evaluation of a “simulator-based” ultrasound training program for university teaching in obstetrics and gynecology–the prospective GynSim study

This study addresses the challenges of ultrasound education in obstetrics and gynecology, focusing on the potential benefits of simulation techniques in medical training. Aiming to evaluate the impact of a structured simulator-based training program, this prospective, randomized, interventional study examines its effects on educational outcomes for 5th year medical students.

Source:
  1. Weimer J, Recker F, Hasenburg A, Buggenhagen H, Karbach K, Beer L, Weimer A, Schiestl L, Lorenz L, Kloeckner R and Dionysopoulou A (2024) Development and evaluation of a “simulator-based” ultrasound training program for university teaching in obstetrics and gynecology–the prospective GynSim study. Front. Med. 11:1371141. doi: 10.3389/fmed.2024.1371141

Ten hours of simulator training in arthroscopy are insufficient to reach the target level based on the Diagnostic Arthroscopic Skill Score

Our data have demonstrated that arthroscopic skills can be taught effectively on a simulator, but a 10-h course is not sufficient to reach the target level set by experienced arthroscopists. However, learning progress can be monitored more objectively during simulator training than in the operating room, and simulation may partially replace the current practice of arthroscopic training.

Source:
  1. Anetzberger H, Reppenhagen S, Eickhoff H, Seibert FJ, Döring B, Haasters F, Mohr M, Becker R. Ten hours of simulator training in arthroscopy are insufficient to reach the target level based on the Diagnostic Arthroscopic Skill Score. Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1471-1479. doi: 10.1007/s00167-021-06648-y.

Surgical simulation training should become a mandatory part of orthopaedic education

This study suggests that surgical simulation training is well accepted and even demanded among surgical residents as an alternative training solution able to address some of the limitations and challenges of the current one-to-one apprenticeship model. There is a wide variation among the residents regarding the number of training hours required, underscoring the need for structured performance-based simulator training.

Source:
  1. Seil R, Hoeltgen C, Thomazeau H, Anetzberger H, Becker R. Surgical simulation training should become a mandatory part of orthopaedic education. J Exp Orthop. 2022 Feb 28;9(1):22. doi: 10.1186/s40634-022-00455-1.

The Diagnostic Arthroscopy Skill Score (DASS): a reliable and suitable assessment tool for arthroscopic skill training

The results of this study indicate good validity and reliability of DASS for the assessment of the surgical performance of diagnostic knee arthroscopy during simulator training. Standardized training is recommended before arthroscopy surgery is considered in patients.

Source:
  1. Anetzberger H, Becker R, Eickhoff H, Seibert FJ, Döring B, Haasters F, Mohr M, Reppenhagen S. The Diagnostic Arthroscopy Skill Score (DASS): a reliable and suitable assessment tool for arthroscopic skill training. Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):349-360. doi: 10.1007/s00167-021-06554-3.

Validation of Virtual Reality Arthroscopy Simulator Relevance in Characterising Experienced Surgeons

Virtual reality (VR) simulation is particularly suitable for learning arthroscopy skills. Despite significant research, one drawback often outlined is the difficulty in distinguishing performance levels (Construct Validity) in experienced surgeons. Therefore, it seems adequate to search new methods of performance measurements using probe trajectories instead of commonly used metrics.

Source:
  1. Tronchot A, Berthelemy J, Thomazeau H, Huaulmé A, Walbron P, Sirveaux F, Jannin P. Validation of virtual reality arthroscopy simulator relevance in characterising experienced surgeons. Orthop Traumatol Surg Res. 2021 Dec;107(8):103079. doi: 10.1016/j.otsr.2021.103079.

Cadaver versus Simulator Based Arthroscopic Training in Shoulder Surgery

There are few studies that compare the cadaver dissections with the medical simulators in means of talent improvement. Therefore, the aim of this study is to find out if using cadaver dissections is still the golden standard for surgical training or using the medical simulators in surgery could replace cadaver dissections

Source:
  1. Huri G, Gülşen MR, Karmış EB, Karagüven D. Cadaver versus simulator based arthroscopic training in shoulder surgery. Turk J Med Sci. 2021 Jun 28;51(3):1179-1190. doi: 10.3906/sag-2011-71.

The ASSET Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy

The purpose of this study is to further evaluate the construct validity and interobserver reliability of a hip arthroscopy virtual simulator using the Arthroscopic Surgery Skill Evaluation Tool (ASSET) global rating scale.

Source:
  1. Bishop ME, Ode GE, Hurwit DJ, Zmugg S, Rauck RC, Nguyen JT, Ranawat AS. The Arthroscopic Surgery Skill Evaluation Tool Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy. Arthroscopy. 2021 Jun;37(6):1856-1866. doi: 10.1016/j.arthro.2021.01.046.

Module-Based Arthroscopic Knee Simulator Training Improves Technical Skills in Naive Learners: A Randomized Trial

Module-based simulation training provides additional training time and improves technical skills in naive health science students. It is hoped that this effect can be preserved and applied to junior resident developing in a busy residency program.

Source:
  1. Beaudoin A, Larrivée S, McRae S, Leiter J, Stranges G. Module-Based Arthroscopic Knee Simulator Training Improves Technical Skills in Naive Learners: A Randomized Trial. Arthrosc Sports Med Rehabil. 2021 May 14;3(3):e757-e764. doi: 10.1016/j.asmr.2021.01.016.

Active vs Passive Haptic Feedback Technology in Virtual Reality Arthroscopy Simulation: Which is Most Realistic?

Virtual Reality (VR) simulators are playing an increasingly prominent role in orthopaedic training and education. Face-validity - the degree to which reality is accurately represented - underpins the value of a VR simulator as a learning tool for trainees. Despite the importance of tactile feedback in arthroscopy, there is a paucity for evidence regarding the role of haptics in VR arthroscopy simulator realism.

Source:
  1. Vaghela KR, Trockels A, Carobene M. Active vs passive haptic feedback technology in virtual reality arthroscopy simulation: Which is most realistic? J Clin Orthop Trauma. 2021 Feb 18;16:249-256. doi: 10.1016/j.jcot.2021.02.014. Erratum in: J Clin Orthop Trauma. 2021 Jul 30;20:101539.

Simulation-based Arthroscopic Skills Using a Spaced Retraining Schedule Reduces Short-term Task Completion Time and Camera Path Length

The aim of this study was to investigate whether acquiring basic knee arthroscopic skills via a spaced retraining schedule could prevent skills deterioration and achieve further skills improvement.

Source:
  1. Li W, Zhang KJ, Yao S, Xie X, Han W, Xiong WB, Tian J. Simulation-Based Arthroscopic Skills Using a Spaced Retraining Schedule Reduces Short-Term Task Completion Time and Camera Path Length. Arthroscopy. 2020 Nov;36(11):2866-2872. doi: 10.1016/j.arthro.2020.05.040.

Surgical Games: A Simulation-Based Structured Assessment of Orthopedic Surgery Resident Technical Skill

We describe the development and implementation of a timed, multitask, station-based Surgical Games to evaluate orthopedic resident surgical skills. (ArthroS™, VirtaMed AG, Schlieren, Switzerland)

Source:
  1. Blevins JL, Felix KJ, Ling DI, Sculco PK, McCarthy MM, Demetracopoulos CA, Ranawat AS, Fufa DT. Surgical Games: A Simulation-Based Structured Assessment of Orthopedic Surgery Resident Technical Skill. J Surg Educ. 2020 Nov-Dec;77(6):1605-1614. doi: 10.1016/j.jsurg.2020.05.009.

Virtual Reality Simulator Improves the Acquisition of Basic Arthroscopy Skills in First-year Orthopedic Surgery Residents

Arthroscopy training using a virtual reality (VR) simulator is said to improve the training of orthopedic surgery residents, although it has never been evaluated in a large representative population of first-year residents.

Source:
  1. Walbron P, Common H, Thomazeau H, Hosseini K, Peduzzi L, Bulaid Y, Sirveaux F. Virtual reality simulator improves the acquisition of basic arthroscopy skills in first-year orthopedic surgery residents. Orthop Traumatol Surg Res. 2020 Jun;106(4):717-724. doi: 10.1016/j.otsr.2020.03.009.

Validation of a Novel Hip Arthroscopy Simulator: Establishing Construct Validity

To assess the face, content and construct validity of a virtual reality hip arthroscopy simulator (ArthroS™, VirtaMed AG, Schlieren, Switzerland)

Source:
  1. Cychosz C, Khazi ZM, Karam M, Duchman K, Willey M, Westermann R. Validation of a novel hip arthroscopy simulator: establishing construct validity. J Hip Preserv Surg. 2019 Dec 10;6(4):385-389. doi: 10.1093/jhps/hnz059.

Lessons Taught by a Knee Arthroscopy Simulator About Participants in a European Arthroscopy Training Programme

Investigates the hypothesis that a theoretical and practical training course improves the scores achieved on an arthroscopy simulator task.

Source:
  1. Baumann Q, Hardy A, Courage O, Lacombes P, Accadbled F; European Paediatric Orthopaedic Society Sports Study Group; Junior French Arthroscopic Society. Lessons taught by a knee arthroscopy simulator about participants in a European arthroscopy training programme. Orthop Traumatol Surg Res. 2019 Dec;105(8S):S287-S291. doi: 10.1016/j.otsr.2019.09.008.

Validation of the Hip Arthroscopy Module of the VirtaMed Virtual Reality Arthroscopy Trainer

To assess the face, content and construct validity of a virtual reality hip arthroscopy simulator (ArthroS™, VirtaMed AG, Schlieren, Switzerland)

Source:
  1. Gallagher K, Bahadori S, Antonis J, Immins T, Wainwright TW, Middleton R. Validation of the Hip Arthroscopy Module of the VirtaMed Virtual Reality Arthroscopy Trainer. Surg Technol Int. 2019 May 15;34:430-436.

Validation of a Virtual Reality–Based Hip Arthroscopy Simulator

To assess construct and face validity of a novel virtual reality–based hip arthroscopy simulator using the previously validated Arthroscopic Surgery Skills Evaluation Tool (ASSET), metric parameters, and a questionnaire.

Source:
  1. Bauer DE, Wieser K, Aichmair A, Zingg PO, Dora C, Rahm S. Validation of a Virtual Reality-Based Hip Arthroscopy Simulator. Arthroscopy. 2019 Mar;35(3):789-795. doi: 10.1016/j.arthro.2018.10.131.

Efficacy of an Arthroscopic Virtual Based Simulator for Orthopedic Surgery Residents by Year in Training

Determine the utility of the ArthroS™ arthroscopic simulator for orthopedic trainees based on their level of training (to determine at what point in training the simulator offers the most benefit for trainees).

Source:
  1. Yari SS, Jandhyala CK, Sharareh B, Athiviraham A, Shybut TB. Efficacy of a Virtual Arthroscopic Simulator for Orthopaedic Surgery Residents by Year in Training. Orthop J Sports Med. 2018 Nov 21;6(11):2325967118810176. doi: 10.1177/2325967118810176.

Efficacy of standardized training for arthroscopic motor skills

Most studies demonstrated, that training on a virtual reality based arthroscopy simulator leads to an improvement of technical skills in orthopaedic surgery. However, how long and what kind of training is optimal for young residents is unknown. In this study we tested the efficacy of a standardized, competency based training protocol on a validated virtual reality based knee- and shoulder arthroscopy simulator.

Source:
  1. Rahm S, Wieser K, Bauer DE, Waibel FW, Meyer DC, Gerber C, Fucentese SF. Efficacy of standardized training on a virtual reality simulator to advance knee and shoulder arthroscopic motor skills. BMC Musculoskelet Disord. 2018 May 16;19(1):150. doi: 10.1186/s12891-018-2072-0.

Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator

Purpose: To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and postgraduate year.

Source:
  1. Tofte JN, Westerlind BO, Martin KD, Guetschow BL, Uribe-Echevarria B, Rungprai C, Phisitkul P. Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator. Arthroscopy. 2017 Mar;33(3):641-646.e3. doi: 10.1016/j.arthro.2016.09.014.

Validation of a virtual reality-based simulator for shoulder arthroscopy

This study was to determine face and construct validity of a new virtual reality-based shoulder arthroscopy simulator which uses passive haptic feedback.

Source:
  1. Rahm S, Germann M, Hingsammer A, Wieser K, Gerber C. Validation of a virtual reality-based simulator for shoulder arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2016 May;24(5):1730-7. doi: 10.1007/s00167-016-4022-4.

Asymmetry in Dominant / Non-Dominant Hand Performance Differentiates Novices from Experts on an Arthroscopy Virtual Reality Serious Game

Safe and effective arthroscopic surgery requires ambidextrous motor skills. The current study examined dominant versus non-dominant hand performance on a virtual reality serious game in a group of expert arthroscopic surgeons (n=15) compared to a group of orthopedic surgery residents (n=10).

Source:
  1. Pedowitz R, Nicandri G, Tuchschmid S. Asymmetry in Dominant / Non-Dominant Hand Performance Differentiates Novices from Experts on an Arthroscopy Virtual Reality Serious Game. Stud Health Technol Inform. 2016;220:289-94.

Comparison Of Three Virtual Reality Arthroscopic Simulators As Part Of An Orthopedic Residency Educational Curriculum

Orthopedic education continues to move towards evidence-based curriculum in order to comply with new residency accreditation mandates. There are currently three high fidelity arthroscopic virtual reality (VR) simulators available, each with multiple instructional modules and simulated arthroscopic procedures. The aim of the current study is to assess face validity, defined as the degree to which a procedure appears effective in terms of its stated aims, of three available VR simulators.

Source:
  1. Martin KD, Akoh CC, Amendola A, Phisitkul P. Comparison of Three Virtual Reality Arthroscopic Simulators as Part of an Orthopedic Residency Educational Curriculum. Iowa Orthop J. 2016;36:20-5

Which Global Rating Scale? A Comparison of the ASSET, BAKSSS, and IGARS for the Assessment of Simulated Arthroscopic Skills

With the move to competency-based models of surgical training, a number of assessment methods have been developed. Of these, global rating scales have emerged as popular tools, and several are specific to the assessment of arthroscopic skills. Our aim was to determine which one of a group of commonly used global rating scales demonstrated superiority in the assessment of simulated arthroscopic skills.

Source:
  1. Middleton RM, Baldwin MJ, Akhtar K, Alvand A, Rees JL. Which Global Rating Scale? A Comparison of the ASSET, BAKSSS, and IGARS for the Assessment of Simulated Arthroscopic Skills. J Bone Joint Surg Am. 2016 Jan 6;98(1):75-81. doi: 10.2106/JBJS.O.00434

Evaluation of a virtual-reality-based simulator using passive haptic feedback for knee arthroscopy

Simulator training in orthopaedics is still in its infancy. The aim of this study is to determine face and construct validity of a new virtual reality simulator (VirtaMed ArthroS™) for diagnostic and therapeutic knee arthroscopy by analysis of simulator metrics of participants with varying arthroscopy experience.

Source:
  1. Fucentese SF, Rahm S, Wieser K, Spillmann J, Harders M, Koch PP. Evaluation of a virtual-reality-based simulator using passive haptic feedback for knee arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):1077-85. doi: 10.1007/s00167-014-2888-6.

Virtual Reality Simulator for Training on Photoselective Vaporization of the Prostate with 980 nm Diode Laser and Learning Curve of the Technique

The utility of a virtual reality simulator for training of the photoselective vaporization of the prostate with diode laser was studied.

Source:
  1. Actas Urológicas Españolas (English Edition), Vol. 38. Issue 7. pages 451-458 (September 2014)

Virtual reality simulator for training urologists on transurethral prostatectomy

As a new method of training on transurethral prostatectomy skills, training of TURP using a virtual simulator can help urologists improve their surgical skills and safety. Therefore, the application of the TURPSim™ system in education and training of urologic surgery is warranted.

Source:
  1. Chin Med J 2013;126 (7): 1220-1223

Face validity, construct validity and training benefits of a virtual reality TURP simulator

Virtual reality (VR) surgical simulators provide repetitive practice and performance feedback without requiring supervision in a safe environment. Simulators have the potential to shorten the learning curve for complex surgical procedures, create skills which transfer to the operating room and therefore decrease the incidence of future complications. Experts resected a significantly greater percentage of prostate per minute [...] and had significantly less active diathermy time without tissue contact [...] than novices.

Source:
  1. Int J Surg. 2012;10(3):163-6.

Visual Control Strategies of Surgeons: A Novel Method of Establishing the Construct Validity of a Transurethral Resection of the Prostate Surgical Simulator

Significant differences between experts and novices in both performance and visual control strategy were observed. The study of visual control strategies may be a useful adjunct, alongside measurements of motor performance, providing a novel method of assessing the construct validity of surgical simulators.

Source:
  1. PII: S1931-7204(13)00289-4

Learning effects using a TURP simulator: Assessing changes in visual control and performance

Surgical simulators afford trainees the chance to practice skills in a safe environment and without the need for supervision. Although they have been proposed to shorten the learning curve for complex surgical skills, there is concern that they do not prepare trainees for the demanding conditions of the operating room. Research in skill learning (including surgical skills) has shown that experts and novices can be distinguished by differences in their visual control strategies, with experts using fewer fixations of a longer duration. The aim of this study was to assess the learning benefits of a TURP simulator by examining, not only changes in novice performance, but also changes in their visual control.

Source:
  1. Technology & Instruments: Surgical Education & Skills Assessment/Ureteroscopy II Moderated Poster

Simulator Based Development of “Trans-Urethral Resection of Prostate” Skills and implementation of “Global Rating Scale” Evaluation System in Urology Postgraduate training

After the introduction of simulators in urology, education in urology has evolved significantly. Specially in endourology, development of Transurethral Resection of Prostate (TURP) skills are shifted from “direct on patient” to simulator based learning. we evaluated the development of TURP procedure skills based on virtual reality simulator (VirtaMed | UroSim™) and assessment of skills based on Global Rating Scale (GRS) evaluation system.

Source:
  1. Poster presented at the World Congress of Endourology (WCE), Vancouver, September 2017

Evaluation of the educational value of a virtual reality TURP simulator according to a curriculum-based approach

This study aimed to evaluate the place of the TURPsim (VirtaMed) within a urologic residency training curriculum, including training needs analysis (TNA) and investigating its validity.

Source:
  1. Simul Healthc. 2014 Oct;9(5):288-94.

Construct validity of UroSim® simulator for learning transurethral resection of bladder tumor

There is an increasing trend to incorporate Simulator-based training in urology residency programs. The study was designed to determine the construct validity of UroSim® for that we compared the performance of transurethral resection of bladder tumor (TURBT) between experts and novices.

Preliminary Experience with Virtual Reality Simulation vs. Animal Model for Hysteroscopic Myomectomy Training

The HystSim™ Virtual Reality hysteroscopic trainer was felt to be at least equal to the ‘‘gold standard’’ pig bladder model for training in hysteroscopic myomectomy with the additional advantages of reproducibility and measurement of results. Further studies comparing modalities and relating results to operating room performance are warranted.

Source:
  1. Center for the Advancement of Minimally Invasive Pelvic Surgery, University of South Florida College of Medicine, Tampa, FL; Obstetrics and Gynecology, University Hospital of Zurich, Zurich, Switzerland

Establishing construct validity of a virtual-reality training simulator for hysteroscopy via a multimetric scoring system

The aims of this study are to determine construct validity for the HystSim™ virtual reality (VR) training simulator for hysteroscopy via a new multimetric scoring system (MMSS) and to explore learning curves for both novices and experienced surgeons.
 

Source:
  1. Surg Endosc. 2010 Jan;24(1):79-88.

Evaluation of a new virtual-reality training simulator for hysteroscopy

Face validity has been established for a new hysteroscopic surgery simulator. Potential trainees and trainers assess it to be a realistic and useful tool for the training of hysteroscopy. Further systematic validation studies are needed to clarify how this system can be optimally integrated into the gynecological curriculum.

Source:
  1. Surg Endosc. 2009 Sep;23(9):2026-33.

Hysteroscopic Resection on Virtual Reality Simulator: What do We Measure?

The objective was to compare results of two groups of population (novices and experts) on a virtual reality simulator of hysteroscopy resection for different metrics and for a multimetric score to assess its construct validity.

Source:
  1. Journal of Gynecology Obstetrics and Human Reproduction

Assessment of a high-fidelity mobile simulator for intrauterine contraception training in ambulatory reproductive health centres

Little is known about the utility of simulation-based training in office gynaecology. The objective of this cross-sectional study was to evaluate the self-reported effectiveness and acceptability of the PelvicSim™ (VirtaMed), a highfidelity mobile simulator, to train clinicians in intrauterine device (IUD) insertion.

Source:
  1. Journal of European CME 2016, 5: 30416

Evaluation of the HystSim™-virtual reality trainer: an essential additional tool to train hysteroscopic skills outside the operation theater

Minimally invasive surgery is a major pillar of gynecological surgery. However, there are very few training opportunities outside the operation theater (OR) due to the cost and equipment requirements of organ simulators, virtual reality trainers (VRT) are promising tools to fill this gap.

Source:
  1. Surgical Endoscopy, pp 1-8

Standardizing Hysteroscopy Teaching: Development of a Curriculum Using the Delphi Method

Hysteroscopy is performed often and in many indications but is challenging to learn. Hands-on training in live patients faces ethical, legal, and economic obstacles. Virtual reality simulation may hold promise as a hysteroscopy training tool. No validated curriculum specific in hysteroscopy exists. The aim of this study was to develop a hysteroscopy curriculum, using the Delphi method to identify skill requirements.

Source:
  1. Journal of Gynecology Obstetrics and Human Reproduction, Volume 47, Issue 6, June 2018, Pages 247-252

Integration and Validation of Hysteroscopy Simulation in the Surgical Training Curriculum

The primary objective of our study was to test the construct validity of the HystSim hysteroscopic simulator to determine whether simulation training can improve the acquisition of hysteroscopic skills regardless of the previous levels of experience of the participants. The secondary objective was to analyze the performance of a selected task, using specially designed scoring charts to help reduce the learning curve for both novices and experienced surgeons.

Source:
  1. Journal of Surgical Education

Operative and diagnostic hysteroscopy: A novel learning model combining new animal models and virtual reality simulation

Hysteroscopy is one of the most common gynaecological procedure. Training for diagnostic and operative hysteroscopy can be achieved through numerous previously described models like animal models or virtual reality simulation. We present our novel combined model associating virtual reality and bovine uteruses and bladders.

Source:
  1. European Journal of Obstetrics & Gynecology and Reproductive Biology

Holmium Laser Enucleation of the Prostate: Simulation-Based Training Curriculum and Validation

To evaluate the face, content, and construct validity of a novel virtual reality simulator for holmium laser enucleation of the prostate (HoLEP) and to assess its feasibility and acceptability as a training model.

Simulation Training for Embryo Transfer: Findings from the American Society for Reproductive Medicine Embryo Transfer Certificate Course

The American Society for Reproductive Medicine Embryo Transfer Certificate Course data analysis demonstrates the effectiveness of simulator-based ET training for REI fellows across the 3 years of training, regardless of prior experience with live ET.

Source:
  1. Fertility and Sterility

Construct validity of UroSim® simulator for learning transurethral resection of bladder tumor

There is an increasing trend to incorporate Simulator-based training in urology residency programs. The study was designed to determine the construct validity of UroSim® for that we compared the performance of transurethral resection of bladder tumor (TURBT) between experts and novices.