Training of Endourology in Asia

  • Kai Zhang
  • Tao Han
  • Gang Zhu


For over hundred years, the training for surgeon was the accumulation of personal experience following the model of “see one, do one, teach one”. Even when this worked, such training lacked standardization because of different cases and teachers’ experience. This is clearly suboptimal from a safety viewpoint. More importantly, modern clinical ethics sits poorly with surgeons practicing new techniques on patients without any attempt at learning the skills on simulators. Patients are also increasingly reluctant to be the “guinea pigs” for inexperienced surgeons. Asia has a vast territory and a large population, the development of endourology varies greatly among different countries and regions. Systematic training and standardization of technique is in pressing need in Asia, especially in developing countries. In the last couple of decades, numbers of new animal and mechanical models and simulators have been developed and validated. Based on the currently available data, endourological training could help surgeons to gain experience and improve skills outside the operating room in a short time. Efforts should be made to identify the best aspects of every model and procedure-specific simulation courses should be developed and validated. Conclusive data on the training effect and feedback on real clinical environment is also needed in Asia.


Endourology Training Training model 


  1. Aydin A, et al. Simulation-based training and assessment in urological surgery. Nat Rev Urol. 2016a;13(9):503–19.CrossRefGoogle Scholar
  2. Aydin A, et al. Current status of simulation and training models in urological surgery: a systematic review. J Urol. 2016b;196(2):312–20.CrossRefGoogle Scholar
  3. Ballaro A, et al. A computer generated interactive transurethral prostatic resection simulator. J Urol. 1999;162(5):1633–5.CrossRefGoogle Scholar
  4. Barret E, et al. Laparoscopic partial nephrectomy in the pig: comparison of three hemostasis techniques. J Endourol. 2001;15(3):307–12.CrossRefGoogle Scholar
  5. Bele U, Kelc R. Upper and lower urinary tract endoscopy training on Thiel-embalmed cadavers. Urology. 2016;93:27–32.CrossRefGoogle Scholar
  6. Cai JL, et al. Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management. Chin Med J. 2013;126(20):3940–3.PubMedGoogle Scholar
  7. Celia A, Zeccolini G. Ex vivo models for training in endourology: construction of the model and simulation of training procedures. Urologia. 2011;78(Suppl 18):16–20.CrossRefGoogle Scholar
  8. Chandrasekera SK, et al. Basic laparoscopic surgical training: examination of a low-cost alternative. Eur Urol. 2006;50(6):1285–90. 1290–1CrossRefGoogle Scholar
  9. Chiu AW, et al. Laparoscopic nephrectomy in a porcine model. Eur Urol. 1992;22(3):250–4.CrossRefGoogle Scholar
  10. da Cruz JA, et al. Does warm-up training in a virtual reality simulator improve surgical performance? A prospective randomized analysis. J Surg Educ. 2016;73(6):974–8.CrossRefGoogle Scholar
  11. Fujimura T, et al. Validation of an educational program balancing surgeon training and surgical quality control during robot-assisted radical prostatectomy. Int J Urol. 2016;23(2):160–6.CrossRefGoogle Scholar
  12. Ganpule A, Chhabra JS, Desai M. Chicken and porcine models for training in laparoscopy and robotics. Curr Opin Urol. 2015;25(2):158–62.CrossRefGoogle Scholar
  13. Gettman MT, et al. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology. 2002;59(3):446–50.CrossRefGoogle Scholar
  14. Gomes MP, et al. A computer-assisted training/monitoring system for TURP structure and design. IEEE Trans Inf Technol Biomed. 1999;3(4):242–51.CrossRefGoogle Scholar
  15. Hamacher A, et al. Application of virtual, augmented, and mixed reality to urology. Int Neurourol J. 2016;20(3):172–81.CrossRefGoogle Scholar
  16. Mishra S, et al. Percutaneous renal access training: content validation comparison between a live porcine and a virtual reality (VR) simulation model. BJU Int. 2010;106(11):1753–6.CrossRefGoogle Scholar
  17. Mishra S, et al. Training in percutaneous nephrolithotomy. Curr Opin Urol. 2013;23(2):147–51.CrossRefGoogle Scholar
  18. Moglia A, et al. A systematic review of virtual reality simulators for robot-assisted surgery. Eur Urol. 2016;69(6):1065–80.CrossRefGoogle Scholar
  19. Noureldin YA, et al. Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access? World J Urol. 2016;34(5):733–9.CrossRefGoogle Scholar
  20. Phe V, et al. Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery. Int J Med Robot. 2017;13(2)
  21. Ramachandran A, et al. A novel training model for laparoscopic pyeloplasty using chicken crop. J Endourol. 2008;22(4):725–8.CrossRefGoogle Scholar
  22. Sampaio FJ, Pereira-Sampaio MA, Favorito LA. The pig kidney as an endourologic model: anatomic contribution. J Endourol. 1998;12(1):45–50.CrossRefGoogle Scholar
  23. Sinha M, Krishnamoorthy V. Use of a vegetable model as a training tool for PCNL puncture. Indian J Urol. 2015;31(2):156–9.CrossRefGoogle Scholar
  24. Song PH, Ko YH. The surgical skill of a novice trainee manifests in time-consuming exercises of a virtual simulator rather than a quick-finishing counterpart: a concurrent validity study using an urethrovesical anastomosis model. J Surg Educ. 2016;73(1):166–72.CrossRefGoogle Scholar
  25. Soria F, et al. Development and validation of a novel skills training model for retrograde intrarenal surgery. J Endourol. 2015;29(11):1276–81.CrossRefGoogle Scholar
  26. Strohmaier WL, Giese A. Improved ex vivo training model for percutaneous renal surgery. Urol Res. 2009;37(2):107–10.CrossRefGoogle Scholar
  27. Tjiam IM, et al. Evaluation of the educational value of a virtual reality TURP simulator according to a curriculum-based approach. Simul Healthc. 2014;9(5):288–94.CrossRefGoogle Scholar
  28. Yang B, et al. A novel training model for retroperitoneal laparoscopic dismembered pyeloplasty. J Endourol. 2010;24(8):1345–9.CrossRefGoogle Scholar
  29. Zhang Y, et al. Novel biologic model for percutaneous renal surgery learning and training in the laboratory. Urology. 2008;72(3):513–6.CrossRefGoogle Scholar
  30. Zhang K, Zhu G, Wan B, Wang JY. Application of porcine heart as animal tissue model for 2 micron continuous wave laser endoscopic technique training. Chin J Urol. 2009;30(9):627–9.Google Scholar
  31. Zhu H, et al. Virtual reality simulator for training urologists on transurethral prostatectomy. Chin Med J. 2013;126(7):1220–3.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Kai Zhang
    • 1
  • Tao Han
    • 2
  • Gang Zhu
    • 1
  1. 1.Department of UrologyBeijing United Family HospitalBeijingChina
  2. 2.Department of UrologyNingxia People’s HospitalNingxiaChina

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