Introduction: Flexible ureteroscopy (fURS) is a one-person surgical technique, limiting trainees’ ability to practice intra-operatively. Although well-suited for simulation training, few existing fURS simulators reproduce accurate, complex renal collecting system anatomies. We developed an anatomically accurate fURS simulator using 3D reconstructions of CT urograms and 3D printing technology to address this need. Methods: Patient-specific CT urograms were used to create 3D reconstructions of the renal collecting system using SlicerTM. 3D models were modified using BlenderTM. Hollow elastomer kidney models were created using an Objet 3DTM printer. To test and evaluate the new fURS simulator, 25 volunteers were recruited (5 novices, 13 residents, 7 urologists). Participants were asked to explore the model with fURS and were evaluated on their ability to deduce its 3D anatomy, their ability to navigate to prespecified calyces, and their time to task completion. Furthermore, participants were asked to compare the anatomical model to existing fURS benchtop models (Cook MedicalTM and Limb and ThingsTM) on several criteria, including internal visualization; tactile feedback; and overall functional and teaching fidelity, in a survey. Results: We were able to create a fURS simulator that accurately replicates anatomically complex renal collecting systems. In exploring the model, we noted that unlike staff urologists, novices and residents often completely missed lower pole calyces. A survey comparison between our simulator and comparable benchtop simulators revealed consistently better ratings of our simulator on all criteria (p < 0.05). Conclusion: We were able to successfully create an anatomically accurate fURS simulator that provides a more realistic scoping experience. Preliminary testing revealed that trainees will benefit from this simulator particularly with respect to learning how to navigate challenging collecting systems.

中文翻译：

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一种新型输尿管镜训练平台，利用 CT 尿路造影复制复杂的肾集合系统解剖结构

简介：输尿管软镜检查（fURS）是一种单人手术技术，限制了学员术中练习的能力。尽管非常适合模拟训练，但现有的 fURS 模拟器很少能够再现准确、复杂的肾集合系统解剖结构。我们利用 CT 尿路照片的 3D 重建和 3D 打印技术开发了一种解剖学上精确的 fURS 模拟器来满足这一需求。方法：使用 SlicerTM，使用患者特异性 CT 尿路照片来创建肾集合系统的 3D 重建。使用 BlenderTM 修改 3D 模型。使用 Objet 3DTM 打印机创建中空弹性体肾脏模型。为了测试和评估新的 fURS 模拟器，招募了 25 名志愿者（5 名新手、13 名住院医师、7 名泌尿科医生）。参与者被要求使用 fURS 探索模型，并评估他们推断 3D 解剖结构的能力、导航到预先指定的肾盏的能力以及完成任务的时间。此外，参与者还被要求根据多项标准将解剖模型与现有的 fURS 台式模型（Cook MedicalTM 和 Limb and ThingsTM）进行比较，包括内部可视化；触觉反馈; 一项调查显示，整体功能和教学保真度。结果：我们能够创建一个 fURS 模拟器，可以准确地复制解剖学上复杂的肾集合系统。在探索该模型时，我们注意到，与泌尿科医生不同，新手和住院医师经常完全错过下极肾盏。我们的模拟器与同类台式模拟器之间的调查比较显示，我们的模拟器在所有标准上的评级始终较高（p < 0.05）。结论：我们能够成功创建一个解剖学上准确的 fURS 模拟器，提供更真实的观察体验。初步测试表明，学员将从该模拟器中受益，特别是在学习如何驾驭具有挑战性的收集系统方面。