Simulation training in percutaneous nephrolithotomy: where are we standing? – a systematic review from EAU endourology

PURPOSE OF REVIEW: The purpose of this systematic review is to summarize all applications of simulation training in percutaneous nephrolithotomy (PCNL), including virtual reality (VR) simulators, 3D-printed and ex vivo models, and cadavers. RECENT FINDINGS: A systematic search of PubMed, Scopus, and Cochrane databases was performed. The simulation method varied between studies. 3D models were used in seven studies, cadavers were used in two studies and VR simulators were used in seven studies. The VR simulator was Marion K181 in two studies, the PERC Mentor in two studies, and the C-Arm Trainer simulator in two studies. One study used 3D ultrasound VR simulation derived from 2D CT scans. Ex vivo models were reported in four studies, while one study used a simple nonbiological model. The puncture method was ultrasound-guided in 9 studies, fluoroscopy-guided in 12 studies, and both methods in 2 studies. Both triangulation and bull's-eye techniques were reported during fluoroscopy-guided punctures, while one study also reported iPad assistance during puncture. SUMMARY: Simulation training in PCNL is both feasible and effective, with proven benefits for urologists of all levels of expertise and patients. Recently, innovative simulation-based teaching approaches have been described, using the already established simulators.