Endoflex - the first portable virtual simulator for flexible ureterorenoscopy (fURS): pilot study

The market for virtual reality simulators designed to simulate retrograde intrarenal kidney stone (RIRS) surgery, utilising flexible ureteroscopes, is highly limited and dominated by a handful of simulators. The objective of our research is to carry out a pilot study and to provide a description of Endoflex, a transportable virtual flexible ureterorenoscopy simulator for kidney stone treatment.

Seventeen novices were recruited, and each performed a virtual ureterorenoscopy with lithotripsy and lithoextraction. The cavity and location of the stone were determined randomly using the random.org portal. The same scenario was used after an educational week, to define changes in metrics. The time taken for the entire simulation, lasing time, fluoroscopic time, stone-free rate, novices' opinions regarding the usefulness of such a simulator in their training, and its impact on their motivation to continue learning endourological skills were evaluated. Three experienced endourologists were asked about the face and content validity.

There was a significant decrease in simulation time, activated laser time, and fluoroscopy time. The number of novices who fully cleared the pelvicalyceal system increased from 11 to 15 (out of 17). All participants found the Endoflex simulator to be useful for their education. The face and content validity estimated was 4 each for face and content validity.

Endoflex is a promising VR-simulator that can be implemented in urological simulation-based training. However, further improvements are necessary for its full-fledged training of RIRS.