BERKELEY, CA (UroToday Inc.) - Initiated by Preminger and colleagues and recently expanded by a group of urologists including John Denstedt, Peggy Pearle, and Elspeth McDougall, in collaboration with Symbionix, virtual ureteroscopy is coming to a surgical arcade near you. Long dismissed as a "video game" or "interactive cartoon", this latest rendition has gone to the next level of becoming a serious tool for training. In this study, comprising 16 medical students and 16 urology residents, the authors were able to demonstrate that the Uromentor had predictive criterion validity for medical students who were ureteroscopically naïve; specifically, the performance of the students on the Uromentor (i.e. after 10, 30 minute sessions over 2 weeks) was predictive of their performance, both qualitatively and timed, in either cannulating the ureteral orifice with a guidewire or passing the ureteroscope over a preplaced guidewire in a cadaver. However, this did not hold true for the Urology residents.

As such, this particular form of VR may serve as a valuable training tool for Urology bound interns; however, at this time, it can not serve as a means for either testing or certification of resident or postgraduate urologists. Perhaps the performance of more complicated VR procedures (e.g. ureteroscopic stone retrieval) would better differentiate among the residents. What is apparent are two things: a.) more work needs to be done to develop a VR machine that will have proven validity at all stages of a surgeon's training and during the postgraduate years and b.) in the future, the certification process for all surgeons may well involve manual (i.e.VR) as well as cognitive (i.e. oral and written) assessments. Unlike flight simulators, surgical simulators have not risen to the degree of scientifically proven sophistication whereby for the surgeon in training or the skilled surgeon, the simulator equates to clinical reality. But then again, this is just the beginning.

J. Urol. 172: 667-671, August, 2004