Advances in urology necessitate continuing instruction and education. The URO-MENTOR enables realistic training of urological methods. The repeatability of the manipulations and the functions analysis guarantee a quality of education of the highest level.

In order to accomplish safe and effective diagnostic and therapeutic endourologic methods, urologists require intensive training and long, practical experience. New developments are now available for treating special areas of application, such as upper urinary tract infections.

Advances in 3-D technology enable computer-based realization of such a simulator. Previous simulators were not appropriate for other endoscopic procedures than transurethral prostatic resection. A demonstration in “real-time” and tactile feedback were not implemented. The goal of the creator was to develop a simulator that enables the recreation of cystoscopy and ureteroendoscopy.

Material and Methods
Collaboration with Simbionix resulted in the development of a simulator based on an Intel Pentium computer. The core programming language is C++ and is responsible for the visualization engine SVE, which enables both a simulation in “real-time”, as well as compatibility with Microsoft’s DirectX and OpenGL-Platform.

Deliverables
The URO MENTOR enables the simulation of cystoscopic and ureterorendoscopic procedures with both rigid and flexible instruments.
{This section also mentions the following advantages:

• Making endoscopic and X-ray inspections in “real-time”
  
• Enabling simulation of retrograde injection of the contrast agent through the body cavity
  
• Allowing the user to become familiar with a great number of endourologic instruments
  
• Providing the opportunity to become familiar with the endourological instruments required in a clinic in a realistic manner, such as:
  • Cystoscopy
  • Retrograde pyelogram
  • Insertion of the lead wire under x-ray observation
  • Insertion of a tool next to or over the lead wire
  • Stone disintegration with various lithotripter probes
  • Insertion of stents.

Therefore, it is possible to simulate a very diverse number of realistic clinical cases, producing a performance analysis. This includes relevant parameters to enable training assessment and improvements. This offers much more information than an instructor in the clinic could provide or produce. During the training sessions, experienced and prospective endourolgists confirm that the URO MENTOR represents images of procedures in “real-time” with a great degree of realism. The system is well-suited for didactic purposes, as well as for learning more difficult endourologic processes. Through the training, participants admit that the system provides great advantages over previous training tools, cadavers and silicon models. Experienced urologists confirm that they are better equipped to manage complications during urological procedures after the training.

Illustration 1a: Lead wire in urinary tract
Illustration 1b: urethroscopic image of ureter
Illustration 1c: Stone disintegration by way of laserprobe
Illustration 1d: Extraction of fragments by way of Dormia basket

Discussion
Endourology is one of the most difficult operative techniques to learn. The rate of complications, even in experienced hands, is dependent on significant frequency of procedures and the capability of the physician. In the past, it was not possible by means of simulation to provide an alternative. Young physicians were forced to acquire the respective technique through practice on much less realistic models.

Compared to previous simulation systems, the URO MENTOR is a modular and cost-effective solution for various endoscopic procedures. Of course, individual experience with patients cannot be completely replaced through simulation. Nevertheless, realistic simulation is important in building experience with endoscopic procedures, as well as fine-tuning technique and tactic. Through simulator training, learned physicians can educate physicians’ assistants, for example, through tricks and experience without the pressure of time. A further advantage is the opportunity for group training among assistant personnel that provides an opportunity for teamwork between the physician and experienced assistants, which is a requirement for the successful execution of endourological procedures.

Among the most important advantages of this computer-based simulation is the reduction of complications, the shortening of operation time, and the avoidance of repeated mistakes on the patients. Furthermore, as with pilots during flight simulation, continual monitoring is possible for ensuring quality of competence.

In order to add to the simulator’s module library, at the moment further procedures are being implemented. In addition to the prostate and TUR procedures, attention is being given to percutaneous “Nephrolithoapaxie” (PCNL). Further tests are being done to validate the system. Moreover, simulation systems are being developed simultaneously by teams for laparoscopy.

Authors: Maurice Stephan Michel, Thomas Knoll, Kai Uwe Koehrmann, Peter Alken
Author’s Address: Dr. med., Maurice Stephan Michel, Urological Clinic, University Hospital of Mannheim, Theodor-Kutzer Bank, 68135 Mannheim. Telephone: +49.621.383.4029. Email: Maurice-stephan.michel@uro.ma.uni-heidelberg.de

Disclaimer: This translation does not proport to be a word for word translation, but rather is more in the nature of a summary of the main points of the original article.

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