450
and experts (≥10 LRN) and, therefore, was “not suitable for implementation in a
urologic training program” in its present form [ 48 ].
Recently created, there are now patient-specific simulations that allow sur-
geons to rehearse before surgery. Makiyama et al. first developed this technology,
in a study in which they successfully generated a VR simulator with specific
patient anatomy (Fig. 24.4) [ 49 ]. The simulator uses dynamic CT images (1 mm
slice early phase CT on 64 detector spiral CT) of the patient of interest, and a
complex model data generator then extracts anatomic information and enters it
into the simulator. The simulator allows for both transperitoneal and retroperito-
neal approaches, and the kidney moves according to positioning (supine vs lat-
eral). The simulator allows the surgeon to place the trocars and camera anywhere
a
c
b
Fig. 24.4 Currently available commercial ureteroscopy simulators, (a) Uro-Scopic Trainer,
(b) URO Mentor, (c) Scope Trainer [ 137 ]
W. Baas et al.