Symu™ (Syrobo®) Simulator: A high- fidelity Versatile tool for Training and Research in Endourology

• Symu™ (Syrobo®) is a high-fidelity, portable simulator reproducing realistic urinary anatomy • Modular design allows training in flexible ureteroscopy and upper tract procedures • Compatible with human and phantom stones (BegoStone™) for standardized lithotripsy testing • Supports use of lasers, baskets, and aspirating access sheaths under reproducible conditions • Provides a versatile platform for both surgical education and device innovation in endourology. Simulation has become a cornerstone of modern endourology. Flexible ureteroscopy (fURS) requires advanced skills, yet current simulation platforms are often limited by poor anatomical fidelity or lack of versatility. The Symu™ (Syrobo®, Paris, France) simulator was developed to overcome these limitations. The Symu™ simulator is a portable, modular platform for fURS, urethrocystoscopy, and upper urinary tract procedures. Its detachable resin-printed anatomical components (kidneys, ureters, bladder, urethra) replicate human anatomy with high fidelity. The system allows the introduction of human or phantom stones, as well as removable tumors, under water-filled conditions. Endoscopic navigation, lithotripsy, and fragment retrieval or aspiration were demonstrated using a flexible ureteroscope, Thulium Fiber Laser (TFL), nitinol baskets, and flexible and navigable suction (FANS) ureteral access sheath (UAS). The simulator permitted realistic navigation through the urinary tract, with optimal visibility and tactile feedback. Lithotripsy of BegoStone™ phantoms was successfully performed with TFL energy, with fragment retrieval with aspiration using traditional UAS and FANS. All components were easily detachable and replaceable, ensuring durability and reproducibility. The Symu™ simulator offers a high-fidelity, portable, and versatile platform for both surgical training and device evaluation in endourology. It enables comprehensive stone management procedures and experimental testing under reproducible conditions.