{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T06:29:39Z","timestamp":1794032979885,"version":"4.8.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"\n Introduction:<\/jats:title>\n \n Simulation has become central in flexible ureteroscopy training and research; however, the lack of standardized and reproducible models limits objective performance assessment. We aimed to evaluate the reliability and reproducibility of laser lithotripsy using morphology-specific artificial stones (AS) within a standardized\n ex vivo<\/jats:italic>\n platform and to assess whether the model could detect operator-dependent differences in lithotripsy performance.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n This study was conducted using AS derived from 3D-printed images of human kidney stones. Six stone volume categories (F1\u2013F6; 250\u20131750 mm\u00b3) were reproduced using BegoStone\n \u00ae<\/jats:sup>\n mixture with ratio of 15:4. Novice and expert surgeons performed\n in vitro<\/jats:italic>\n laser lithotripsy under standardized settings. Performance metrics included ablation efficiency (AE) (mm\u00b3\/J), energy consumption (J\/mm\u00b3), lasing time consumption (s\/mm\u00b3), and laser ablation rate (AR) (mm\u00b3\/min). Results were compared with six matched\n in\u00a0vivo<\/jats:italic>\n reference cases. Adjusted linear models were used to evaluate the effect of operator experience.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n In vivo<\/jats:italic>\n lithotripsy showed a mean laser-on time of 44.9 \u00b1 17.0 minutes, total energy delivery of 32.35 \u00b1 12.2 kJ, AE of 0.03 \u00b1 0.00 mm\u00b3\/J, and laser AR of 21.9 \u00b1 1.78 mm\u00b3\/min, with complete stone clearance in all cases. AS experiments demonstrated shorter laser-on-time than\n in\u00a0vivo<\/jats:italic>\n procedures (37.4\u201338.3 vs 44.9 minutes,\n p<\/jats:italic>\n < 0.01), lower energy delivery (26.9\u201327.9 vs 32.35 kJ,\n p<\/jats:italic>\n < 0.01), higher AE (0.04 vs 0.03 mm\u00b3\/J,\n p<\/jats:italic>\n < 0.01), and higher laser AR (26.0\u201326.8 vs 21.9 mm\u00b3\/min,\n p<\/jats:italic>\n < 0.01). In unadjusted aggregated comparison, expert surgeons showed higher performances than novices, although the differences did not reach statistical significance (\n p<\/jats:italic>\n > 0.05). Adjusted analysis showed that operator experience was significantly associated with both better AE and AR (\n p<\/jats:italic>\n < 0.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n The standardized\n ex vivo<\/jats:italic>\n platform, combining a validated simulation model with 3D-printed morphology-specific AS, provides a reliable and reproducible environment for evaluating laser lithotripsy performance, supporting the objective metrics assessment.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/08927790261473158","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:35:23Z","timestamp":1785584123000},"page":"1340-1348","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of the Symu\n TM<\/sup>\n Flexible Ureteroscopy Platform Based on Real-Life Pulsed Tm:YAG Lithotripsy Using Specific 3D-Printed Artificial Stones"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5593-5995","authenticated-orcid":false,"given":"Federico","family":"Zorzi","sequence":"first","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service d\u2019Urologie, Tenon H\u00f4pital, Paris, France."},{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8759-4652","authenticated-orcid":false,"given":"Marie","family":"Chicaud","sequence":"additional","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service d\u2019Urologie, Tenon H\u00f4pital, Paris, France."},{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Jacquemin","sequence":"additional","affiliation":[{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imade","family":"Koutiri","sequence":"additional","affiliation":[{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Gonzalez-Gonzalez","sequence":"additional","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service d\u2019Urologie, Tenon H\u00f4pital, Paris, France."},{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Scilipoti","sequence":"additional","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service d\u2019Urologie, Tenon H\u00f4pital, Paris, France."},{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."},{"name":"Department of Experimental Oncology\/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy."},{"name":"Vita-Salute San Raffaele University, Milan, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Nannola","sequence":"additional","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service d\u2019Urologie, Tenon H\u00f4pital, Paris, France."},{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."},{"name":"Department of Urology, University of Modena and Reggio Emilia, Modena, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine","family":"Dupuy","sequence":"additional","affiliation":[{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5411-6274","authenticated-orcid":false,"given":"Stessy","family":"Kutchukian","sequence":"additional","affiliation":[{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Moretto","sequence":"additional","affiliation":[{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Berthe","sequence":"additional","affiliation":[{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrille","family":"Guillot-Tantay","sequence":"additional","affiliation":[{"name":"Service d\u2019urologie et de transplantation r\u00e9nale, H\u00f4pital Foch, Suresnes, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Traxer","sequence":"additional","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service d\u2019Urologie, Tenon H\u00f4pital, Paris, France."},{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steeve","family":"Doizi","sequence":"additional","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service d\u2019Urologie, Tenon H\u00f4pital, Paris, France."},{"name":"UMR 8006 CNRS-Arts et M\u00e9tiers ParisTech, PIMM, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic","family":"Panthier","sequence":"additional","affiliation":[{"name":"GRC20-Endolase lab, APHP H\u00f4pital Tenon, Sorbonne University, Paris, France."},{"name":"Service 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