This study aimed to evaluate the effectiveness of systematic simulation-based training using anatomically accurate 3D-printed models in enhancing procedural skills, anatomical understanding, and educational engagement among residents learning retrograde intrarenal surgery (RIRS). The use of such models was explored as a tool to bridge the gap between theoretical learning and clinical practice in a safe, reproducible training environment.

This prospective cohort study involved 89 participants (54 medical students and 35 urology residents) enrolled in a structured simulation-based training program. Patient CT scans were used to create 3D reconstructions of the upper urinary tract. Anatomically accurate kidney and ureter models were fabricated using polymeric materials, with embedded stone fragments (both real and artificial) to replicate clinical scenarios.
Training was conducted using flexible ureterorenoscopes and a thulium fiber laser under ex vivo conditions. All participants completed a two-week training course involving one hour of hands-on simulation daily. The curriculum focused on key components of RIRS: renal access, endoscopic navigation, stone fragmentation, and laser lithotripsy.
Assessment tools included timing of procedural tasks (e.g., stone fragmentation), pre- and post-course anatomy knowledge tests, and self-assessment questionnaires on technical confidence and educational value.

The 3D-printed simulator successfully replicated key steps of retrograde intrarenal surgery and was effectively used across all training sessions. For 100% of medical students and 32% of residents, the program provided their first hands-on experience with laser lithotripsy. Following the two-week simulation course, participants demonstrated marked improvements in both objective performance and self-assessed confidence. The average time required for stone fragmentation of 10 mm calculi was reduced by approximately 50% compared to initial performance, indicating a substantial gain in procedural efficiency. Anatomical knowledge scores increased by 20%, from a mean of 63% before training to 83% after training (p < 0.05). In addition, 92% of participants reported a positive impact on their understanding of renal anatomy and endoscopic technique, and 68% noted increased interest in further training in endourology. All trainees completed the full program, and the use of real and artificial calculi provided a high-fidelity, realistic surgical experience. The simulator was well received and demonstrated strong potential for integration into structured urological education.

The observed improvement in technical skill and anatomical knowledge validates the effectiveness of 3D-printed simulation in surgical training. The high levels of user satisfaction and increased motivation suggest that such simulators not only teach practical skills but also stimulate deeper interest in the specialty. The reduction in operative time further supports the simulator’s role in accelerating the learning curve.

Simulation-based training using 3D-printed anatomical models is an effective educational strategy in RIRS, offering safe, reproducible, and engaging opportunities to develop surgical skills. Its integration into formal urological education programs may enhance technical competence and preparedness in early-career urologists.

Aydin A, Baig U, Al-Jabir A, Sarica K, Dasgupta P, Ahmed K. Simulation-Based Training Models for Urolithiasis: A Systematic Review. J Endourol. 2021 Jul;35(7):1098-1117. doi: 10.1089/end.2020.0408.
Brunckhorst O, Aydin A, Abboudi H, Sahai A, Khan MS, Dasgupta P, Ahmed K. Simulation-based ureteroscopy training: a systematic review. J Surg Educ. 2015 Jan-Feb;72(1):135-43. doi: 10.1016/j.jsurg.2014.07.003
Nedbal C, Jahrreiss V, Cerrato C, Pietropaolo A, Galosi A, Veneziano D, Kallidonis P, Somani BK. Role of simulation in kidney stone disease: A systematic review of literature trends in the 26 years. World J Nephrol. 2023 Sep 25;12(4):104-111. doi: 10.5527/wjn.v12.i4.104