EndoWorld

URO 26-1-E/02-2005

Making treatment risk free

Virtual reality transurethral surgical training

Making treatment risk free

Virtual reality transurethral surgical training

Today, the simulation of complex endoscopic procedures by means of virtual

reality (VR), as part of training and further
training, is seen as a very worthwhile goal
in urology. Even on less realistic models,
several groups were able to conclusively
prove that such an approach is of benefit
to trainee physicians [13].
The virtual TUR simulator from
KARL STORZ enables numerous realistic
tasks to be carried out, and thus facilitates
focused individual training. The skills
acquired, for example in personal operating techniques, are continuously improved
and optimized.
Thanks to the range of variable and flexible
software training modules, training can be
provided in anatomy, as well as in the
basics of diagnostic and therapeutic
measures in endourologic interventions.
In particular, the difficult hand-eye coordination, which is needed for the inspection
of the lower urinary tract and for performing therapeutic interventions, can, with the
virtual training module, be practised and
systematically improved so that it
becomes, to a large extent, routine, and a
high level of skill is developed without
endangering patients.
The system enables a percentage evaluation of those parts of the bladder surface
which have been specifically examined;
the distal distance and guidance of the
endoscope in relation to the surface form
part of the evaluation criteria.
To create the feeling of a realistic intervention, a variety of telescopes with different angles of view are available (Fig. 2).
Furthermore, the external appearance of
all the instruments, as well as the functions
of an endoscopic camera, such as focus-

Fig. 1

2 3

ing, have been integrated into the system

to optimize the instrument-related learning
effect (Fig. 3).
The unique Patient creation module simulates the morphology, the position, the size
and the number of tumors randomly, as in
nature.
In this way, unique virtual patients are
created. This greatly increases the success
of training, as each case is different.
Therefore, the trainee physician must continuously adapt to new situations (Fig 5).

Fig. 2

Fig. 5

Fig. 3

Fig. 6

The integrated session manager provides

a choice of micropapillary tumors, flat
carcinomas in situ, as well as a mixed
session offering a complete range of
macropathologic conditions. This gives the
trainee physician an unlimited choice of
new, realistic operating room situations.
To provide training on therapeutic
measures, there is a choice between HF
resection and coagulation with various HF
resection loops, as well as laser application (Fig. 6).
There is even a beep sound integrated into
this system to check that the unit is activated, such as real units have.
Hemorrhages that occur during tumor
resection must be controlled properly by
the trainee physician by means of contact
coagulation, which, like the laser, is triggered by a pedal.
If hemorrhaging is overlooked or coagulation is not performed properly, vision
deteriorates due to the red coloration of
the irrigation liquid. To improve the situation, the trainee has to perform virtual
rinsing. Hemorrhages and any loss of
blood are realistically visualized.
This system allows you to experience HF
resection on simulated tissue in a remarkably realistic manner.
KARL STORZ has achieved this by means
of the patented Force Feedback System
[4.5) integrated into the resectoscope.
Here, the forces resulting from contact
with the bladder wall or resection are
simulated and conveyed realistically to the
user via the instrument.
Fig. 4

4 5

The anatomically flexible bladder wall

looks just like the real thing and therefore
contributes to the realistic overall impression. The bladder content can be easily
simulated at different levels.
The PDD procedure (photodynamic
diagnostics) which has been additionally
integrated into the Indications module
means training now compromises this new
application procedure (Fig. 4) - allowing
this procedure, which is extremely efficient
for tumor recognition, to be trained.

and evaluated in close cooperation with

the Department of Urology ( Prof. Dr. Dr.
h.c. Alfons Hofstetter and Dr. Margarita Noll)
and the Laser Research Laboratory at
Grosshadern University Hospital in Munich.

Prof. Dr. med. Christian Stief,

University Hospital Grosshadern, Munich
Senior physician Dr. med. Oliver Reich,
University Hospital Grosshadern, Munich

New medical indications can be integrated

into the Indications module at any time.
Therefore, from a medical perspective, the
system is always up to date.
As well as the percentage evaluation,
display of the surface of the bladder which
has been inspected, and evaluation of successful tumor resections, the loss of blood
in real time is also transmitted to the
Statistics module.
The latest results and data are displayed
on a second monitor next to the customary endoscopic monitor, to check how
successful learning has been. This data is
transferred cumulatively to the Statistics
module and can be output for each
individual user.
Furthermore, the additional monitor shows
the morphology of the bladder and the
tumors, as well as the current position of
the endoscope with working element
introduced via the instrument port on virtual slice images. With this representation,
even beginners can assess the depth of
the instrument position, something which,
using the endoscopic image, would only
be possible for a very experienced physician.
Simulation of the, in comparison, considerably more complex transurethral resection
of the prostate (TURP) is also available as
an additional option, for the purposes of
training and further training.
Fundamental findings that are the basis for
the implementation of this simulator were
aquired from a project (MISSIMU) sponsored by the EU. The realistic virtual imaging of the TUR simulator was implemented

Bibliography
1 MANYAK MJ, SANTANGELO K, HAHN J ET AL:
Virtual reality surgical simulation for lower
urinary tract endoscopy and procedures.
J Endourol, 16(3):185, 2002
2 SHAH J, MACKY S, VALE J ET AL:
Simulation in urology a role for virtual
reality ?
BJU International, 88:661, 2001
3 HOZNEK A, KATZ R, GETTMAN M ET AL:
Laparoscopic and robotic surgical training in urology.
Curr Urol Rep, 4(2):130, 2003
4 IRION, KM, BHM, R ET AL:
Simulatorvorrichtung mit zumindest zwei
Bewegungsfreiheitsgraden fr die
Verwendung bei einem realen Instrument
Deutsche Patentschrift von KARL STORZ
GmbH & Co. KG, 03.11.2000
5 IRION, KM, BHM, R ET AL:
Simulatorvorrichtung mit zumindest zwei
Bewegungsfreiheitsgraden fr ein
Instrument
EP-Patentschrift von KARL STORZ
GmbH & Co. KG, 03.11.2000
6 NOLL, MARGARITA:
Konzeption und Evaluation eines
Endoskopie-Simulators fr die Urologie.
Dissertation, LMU Mnchen:
Medizinische Fakultt (2003)

57 1000 01

URO Trainer Set, hardware including controller set with

German-language operating system, including camera head;
not including software or resectoscope

57 1000 01U URO Trainer Set, hardware including controller set with
English-language operating system, including camera head;
not including software or resectoscope

6 7

57 0270 50 D Resectoscope, active, for use with

URO Trainer Set 57 1000 01/57 1000 01U

57 0270 50 E Resectoscope, passive, for use with

URO Trainer Set 57 1000 01/57 1000 01U

57 0900 01-01 URO Trainer Software Bladder, German and English

57 090002-01 URO Trainer Software Bladder and Prostate,
German and English
57 0900 03-01 CD Update Bladder and Prostate, German and
English

EndoWorld

KARL STORZ GmbH & Co. KG

Mittelstrae 8, 78532 Tuttlingen, Germany
Postfach 230, 78503 Tuttlingen, Germany
Phone: +49 (0) 74 61 708-0
Fax:
+49 (0) 74 61 708-105
E-Mail: info@karlstorz.de
www.karlstorz.com

KARL STORZ Endoscopy-America, Inc.

600 Corporate Pointe
Culver City, CA 90230-7600, USA
Phone.: +1 310 338 8100
+1 800 421 0837
Fax:
+1 310 410 5527
E-Mail: info@ksea.com

EW URO 26-1-D/02-2005

www.karlstorz.com