A simulator for training urologists
A hardware-software system for practicing retrograde intrarenal surgery (RIRS) skills for kidney stones. The first Russian-developed simulator of its kind — no trips to an animal lab, no consumables, no risk to patients.
Urolithiasis — the scale of the problem
Over fifteen years, the number of urology visits for urolithiasis has grown by almost 15%. It is the most common condition in urology and tends to recur.
Treating urolithiasis — method chosen by stone size
Under the current urolithiasis clinical guidelines (Russian Ministry of Health, 2020), the treatment method is chosen based on stone size and location. RIRS is a key method for lower-pole and medium-sized stones, and mastering it is critical for a modern endourologist.
- RIRS is the modern standard. Flexible ureterorenoscopy with laser lithotripsy replaces open surgery for most kidney stone locations.
- Lower-pole calyx stones of 10–20 mm. A special case: when factors are unfavorable for extracorporeal shock wave lithotripsy (SWL), endourology is indicated — RIRS or percutaneous nephrolithotomy (PCNL).
- Mastery takes volume. Performing RIRS safely and effectively requires repeated practice — on a simulator, this is safe and needs no consumables.
Training endourologists — the bottleneck
Operating time drops sharply as experience builds, but reaching expert level takes a significant number of procedures. Existing training methods have limitations that slow down skill acquisition.
- Strict storage requirements
- Short specimen lifespan
- Require real instruments and consumables
- Ethical and logistical constraints
- Identical anatomy — no variability
- Dependence on 3D printing and materials
- High time and resource costs
- Require real endoscopes and lasers
- Dozens of clinical scenarios — variable anatomy
- No consumables, no biomaterial storage
- Objective assessment: time, pressure, doses
- Practice both individually and as a team
EndoFlex — four core principles
A unique Russian-developed RIRS simulator with no equivalent on the Russian market. It runs standalone, supports team training and can be extended to related disciplines.
Software module — scenarios and simulation
A training software environment with two synchronized views: the endoscopic image from inside the renal collecting system and 3D anatomy with the instrument trajectory. Every attempt is reviewed in a detailed report.
- Choice of clinical scenario. Side, location and stone type — dozens of preconfigured and custom cases to practice on.
- Endoscope parameter settings. Flexibility, deflection angle, irrigation — the trainee chooses a configuration to suit the patient’s anatomy.
- Laser stone fragmentation. Simulation of holmium / thulium laser lithotripsy with fragmentation and dust-cloud physics.
- Basket retrieval of fragments. Grasping, relocation into a calyx, extraction — practicing with a nitinol basket in 3D.
- Detailed session report. Time, collecting system pressure, movement speed, fluoroscopy, laser energy — objective metrics.
The hardware system
The ergonomics of a real operating room: an endoscope-style handle for the trainee, a touchscreen console for the assistant, a foot pedal unit for the laser and a main computing module with a cooling system.
Simulation training — a valid tool
A study by Matsumoto et al. confirmed the validity of ureteroscopy simulation as a tool for assessing endourological skills. EndoFlex builds on this methodology for the Russian training market.
- Objective skill assessment. Simulator metrics correlate with an endourologist’s level of training — from resident to expert.
- Skill transfer to the operating room. Simulator training helps surgeons reach the plateau of the learning curve faster in real surgery.
- Lower risk for patients. Part of the learning curve moves from the operating room into a safe simulation environment.
Evidence base and sources
The EndoFlex simulator is based on current clinical guidelines and scientific publications on endourology and simulation training.