Abstract
Rapid developments in the urological field, as an expanding knowledge base and emerging new techniques require continuing urological education to achieve life long learning and to keep the urologists up to date. Consequently, specific training is necessary to guarantee qualification of the urologists. The goal of the development of the URO mentor (Simbionix, Israel) is to overcome the current drawbacks of traditional training methods for ureterorenoscopy and PNL procedures.

A computer-assisted simulator for training and quality control in ureterorenoscopy and PNL was developed using virtual reality, multimedia technology and intelligent tutoring systems. The software system is the heart of the simulator system. It features the proprietary visualization engine - SVE. SVE makes real-time simulation possible by offering a high level object oriented API (Application Program Interface) written in C++, available for use with either Microsoft® DirectX 7® or OpenGL as platforms. SVE includes general procedures that allows for: 2D and 3D rendering, collision detection, collision correction, 3D morphing, 2D image manipulation, texture mapping, bump mapping, video texture, X-ray rendering, special effects (blood, smoke, stone fragments and more) reflections.
The system allows for a full training session on a wide range of procedures by offering different types of cases and different types of virtual patients. The URO Mentor simulator features full representation of the endourological procedures under direct vision and by using interactive fluoroscopy with a contrast agent. The supported Tools include: baskets, graspers, intracorporal lithotripters, guide wires, catheters, stents, biopsy devices, dilation devices. The following endourological procedures can be performed: lithotripsy, tumor resections, treatment of strictures and obstructions, stent placement, biopsies.
The URO Mentor introduces a new generation mannequin equipped with a special haptic device, providing trainees with an unparalleled true-to-life sensation while training for diagnostic and therapeutic endourological procedures. By bringing key advances in the area of urological simulation--with the real-time x-ray renderer for instance--and by integrating in a single system both high quality simulation and learning tools, the URO Mentor opens new perspectives for computer based urological training systems and methods.

Materials & Methods
URO mentor proprietary technology features:

• three-dimensional computer modeling
• 3D visualization engine
• an innovative and friendly user interface
• scope and tool tracking technologies
• electronic devices including I/O cards
• specially designed haptic devices for realistic force feedback.

The simulated view:
It is a revolutionary technique for building computer modeling of human organs - a non-rigid, elasto-dynamic object. The realtime rendered images simulate stretching, deflation and inflation, contraction and perforation.

The Software Engine and SVE:
The Simulation System is the heart of the software system. It features the proprietary Simbionix Visualization Engine - SVE. SVE makes real-time simulation possible by offering a high level object oriented API (Application Program Interface) written in C++, available for use with either Microsoft® DirectX 7® or OpenGL as platforms.
SVE includes general procedures that allows for:

• 2D and 3D Rendering
• collision detection
• collision correction
• 3D Morphing
• 2D Image Manipulation
• texture mapping
• bump mapping
• video texture
• X-ray rendering
• special effects (blood, smoke, stone fragments and more)
• reflections

Introduction and Objectives
The Simbionix URO Mentor introduces a new generation mannequin equipped with a special haptic device, providing trainees with an unparalleled true-to-life sensation while training for diagnostic and therapeutic endourological procedures. One of the great advantages of the system is the clear picture it affords the trainee at every stage of the endoscopic procedure by giving complete and realistic three-dimensional simulation of the anatomy of the urinary system. The goal of the development of the URO mentor (Simbionix, Israel) is to overcome the current drawbacks of traditional training methods for ureterorenoscopy and PNL procedures.

Conclusion
The concept of the simulator as a training tool is well established, notably in aviation. It is also used for the annual evaluation of pilots prior to their final approval by the authorities. The airline industry has demonstrated that the use of such simulators has improved pilot skill. Pilots are trained on simulators in order to reduce mistakes which may be critical and cost lives.
It is therefor natural that simulators should be used for training in the medical field as well. In recent years advanced simulation technology has been introduced into medicine in several fields such as laparoscopy, cardiology, and anesthesiology. Performing an endoscopy requires skill and training. For each type of procedure there is a minimum number of attempts necessary to achieve competence.
Different organizations have their recommendations for the minimal number of procedures needed for competence.
Many supervising physicians find that they have insufficient time to spend overseeing procedures. Any device which saves time would be valuable. The most obvious example of such a device would be an endoscopic simulator, which would enable the trainee to learn and be tested quickly and safely.
The URO mentor system allows a full training session on a wide range of procedures by offering different types of cases and different types of virtual patients. The simulator features full representation of the endourological procedures under direct vision and by using interactive fluoroscopy with a contrast agent. The supported tools include: baskets, graspers, intracorporal lithotripters, guide wires, catheters, stents, biopsy devices, dilation devices. The following endourological procedures can be performed: lithotripsy, tumor resections, treatment of strictures and obstructions, stent placement, biopsies.
Bearing in mind the simulators already available, the increased public awareness of medical legal issues, and the limited time of supervising physicians, endoscopic training is likely to undergo changes.
Trainees will start their training on a computer-based simulator. Since it is always available, the trainee can practice as long as it is needed and at that time which is convenient for him.
The virtual mentor that exists in such a simulator will constantly improve the trainee's performance. The URO mentor simulator is ideal for this purpose.
Advanced training in therapeutic procedures can also be done with an ex vivo model. However, the use of such a model requires early planning. The pig kidney and ureter needs to be obtained and prepared. Further more the use of X-Rays is limited.
In the very near future the URO mentor simulator will provide the option for PCNL and TUR-P as well as TUR-B. Once this happens, the need for animal models is expected to decline.
In addition, as with flight simulators, computer-based simulators will make continuous monitoring of competence possible. Accurate recording of successes and failures throughout professional life would help individuals recognize areas where they need improvement, and would also help healthcare organizations to identify impaired practitioners.

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