Virtual Reality Endoscopiclaparoscopic Simulation

Endourologic procedures require specific training to achieve competency.

Often, there are reduced training opportunities for residents due to a limited number of clinical cases. Moreover, ethical and cost issues may further limit the use of animal or cadaver models for training purposes (36-38). Hands-on training using bench models can successfully teach the novice laparoscopic skills, but lack the ability to simulate clinical conditions (39). Moreover, inanimate simulators lack the realistic feedback of living tissue.

Advances in virtual reality simulation offer a practical tool for urologists to practice various endourologic procedures from the basic to the most complex in an inanimate, but dynamic, life-like environment without risk for the patients or ethical issues.

A realistic virtual reality surgical simulation consists of accurate reproduction of anatomic structures, appropriate tactile feedback, and spatial cues.

Because endourologic procedures require little in the way of complex anatomic and tactile feedback, one of the earliest simulators in urology was a virtual reality ureteroscopy simulatorc (36,37,40). This simulator allowed urologists to explore the ureter and kidney to identify pathologic processes, e.g., stones and tumors. However, this early simulator was limited by the lack of true anatomical representation and inadequacy in computer graphics. Virtual cystoscopy and ureteroscopy using either rigid or flexible endoscopes can be performed using a new endoscopic simulatordbuilt, applying the most recent advances in computing power, virtual reality graphics, and physical modeling techniques.

Real-time fluoroscopy with simulation of C-arm control and viewing of fluoroscopic images of injected contrast can also be simultaneously combined with simulated endoscopic procedures. Several endourologic procedures including cystoscopy, retrograde pyelography, insertion of guide wire, ureteral stenting, ureteroscopy, stone fragmentation, and fragment removal using various tools can be realistically simulated.

Endourologic procedures require specific training to achieve competency.

Advances in virtual reality simulation offer a practical tool for urologists to practice various endourologic procedures from the basic to the most complex in an inanimate, but dynamic, life-like environment without risk for the patients or ethical issues.

cImmersion Medical, Gaithersburg, MD. dURO Mentor System, Symbionix, Tel Aviv, Israel.

Recent studies have demonstrated that, using this virtual reality simulator, urologic trainees acquired uretero-scopic skills more rapidly.

Recent studies have demonstrated that, using this virtual reality simulator, urologic trainees acquired ureteroscopic skills more rapidly (41-44).

In fact, the use of both laparoscopic and ureteroscopic simulators has led to a significant reduction in the learning curves of both routine and complex endoscopic procedures. Endourologic skills can also be validated using virtual reality simulation (38,45).

Due to further advances in computer and software technology, virtual reality simulation has become more realistic for the performance of laparoscopic procedures (46-49). Similar to the aviation industry, virtual reality simulation will likely be incorporated into the training, testing, and credentialing of endourologists and laparoscopic surgeons over the next 5 to 10 years.

The advantage of "live" video teleconferencing consists of real-time interaction between physicians and patients with full motion audiovisual images, allowing a true physician-patient relationship.

Standardization of input devices for image data exchange is essential for telemedicine. There is an urgent need for future standardization and integration of telemedicine hardware.

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