Working with flexible cystoscope and flexible ureteroscope with integrated direct in-scope suction: do we need training?

BACKGROUND: The aim of the study is to evaluate improvement of surgical skills of residents after training sessions using single-use digital flexible cysto/nephroscope and ureteroscope with direct in-scope suction feature on porcine bladder and kidney models.METHODS: Simulation model of kidney and bladder was developed to imitate kidney stone procedure. Urology residents conducted training sessions using flexible uereteroscopy (fURS) and cystoscope in combination with the Direct in Scope Suction (DISS) feature. The training was performed on a porcine bladder model with a diverticulum, which was created by suturing a porcine gallbladder to the bladder, as well as on a porcine kidney with an attached 15-cm ureter. The training program was designed to enhance residents’ ureteroscope handling skills through structured exercises, including bladder assessment, calyceal navigation, stone relocation skills using Direct In-Scope Suction Feature.RESULTS: The use of porcine bladder and kidney models in training sessions has resulted in considerable improvements in the surgical abilities of urology residents. Three residents took part in the program, and each demonstrated progressive improvement in their ability. The success rate of first-year resident increased from one out of five attempts to three out of five. The second-year resident improved from 2 out of 5 to 5 out of 5 successful relocations, while the third-year resident improved from 4 out of 5 to a complete 5 out of 5. These improvements represent not just increased stone relocation skills, but also significant gains in procedural precision and familiarity with endoscopic procedures.CONCLUSIONS: Novel flexible uretero/cystoscopes with the DISS system represent a recent innovation in endourological procedures. Training sessions using a porcine kidney and bladder model enable residents to enhance their flexible uretero/cystoscope handling skills, reduce procedural time, and better prepare for potential complications during real surgical procedures.