Sacral neuromodulation (SNM) procedure is a neuromodulation operation that is expected to become widespread in the world. It regulates the functions of the systems by stimulating the nerve that regulates bladder and bowel functions with a bladder battery. The electrode uses the signals sent by the battery to stimulate the nerves and regulate the functions of the bladder. In this way, undesirable situations such as overreaction of the bladder are prevented. The critical point of SNM is the detection of the third sacral spinal nerve (S3). During the surgical intervention, this stage takes longer than the other stages of the surgery, and the wrong estimation of the S3 region can lead to anomalies in the surgery.
In this context, thanks to the VR Model developed for the use of this operation, which is performed blindly and with the help of a X ray flouroscopy, in education for people at the beginner level and patients for this surgery, it is possible to have a clear idea about the steps and course of the surgery.

In this study, a number of modeling technique has been used to complete the urological simulator.
The human model is based on T-Pose, and the Anatomy model is adapted to context using Rigging or Morph, and the actual Scan Data is 3D for organs, organized using Retopology, and the external texture is modified to a Substance 3D program, for simulation tools, see Youtube or Google Image Search.
In the SNM simulation, modeling of different men and women was created, and it was necessary to determine whether objects could interact according to the surgical sequence.
Vector 3 Distance was used for separation of surgical tools, and interaction was possible for the next progress after separation. Collider was placed where body feedback should be for needle position and collision was determined. Waypoint system was used to implement flexible objects and move along needle path.
In order to make the body's reaction through electrical stimulation visible, Morph work according to the part of the human body model was required, and Morph work was performed on the buttocks and toes. In addition, the texture for matching the nerve part and the picture part was reworked so that the intubation point could be determined by looking at the picture of the skin, and a touchable device was created to enable interaction with the device that gave electrical stimulation.
All structures modeled by different software unify and put into Cinema 4D platform to create the simulation of SNM procedure (Figure 1 and 2).

In order to determine the effectiveness of the model, a 7-step "surgical step evaluation" test including STEP 1: Patient Position and Preparation, STEP 2: Use of X-Ray and Marking Equipment, STEP 3: Foramen Needle - Placement Equipment, STEP 4: Introducer - Placement Equipment, STEP 5: Tined Lead Electrode - Placement Equipment, STEP 6: Removal of the Introducer Equipment and STEP 7: Tunneling, IPG Pocket, and Percutaneous Extension Lead Equipment determined by the surgeons applying the surgical method was applied to 5 expert urologists. About the surgical step evaluation, mean value was 4,40  in Likert scale (1 poor, 2 marginal, 3 acceptable, 4 good and 5 very good). We also assessed objective structured assessment of technical skill (OSATS) of the expert urologists including Gentleness, Time and Motion, Instrument handling, Flow of operation, Tissue exposure and Summary score with the mean value 4,6 in same Likert scale.

At the end of the training activities with the analysis of the results; all participants completed the end-to-end surgery training and were successful in placing the needle.

Aydogan TB, Patel M, Digesu A, Mourad S, Castro Diaz D, Ezer M, Huri E. Innovative training modality for sacral neuromodulation (SNM): Patient-specific computerized tomography (CT) reconstructed 3D-printed training system: ICS School of Modern Technology novel training modality. Neurourol Urodyn. 2023 Jan;42(1):297-302. doi: 10.1002/nau.25083. Epub 2022 Nov 2. PMID: 36321797.
Tatar I, Huri E, Selçuk I, Moon YL, Paoluzzi A, Skolarikos A. Review of the effect of 3D medical printing and virtual reality on urology training with ‘MedTRain3DModsim’ Erasmus + European Union Project. Turk J Med Sci. 2019 Oct 24;49(5):1257-1270. doi: 10.3906/sag-1905-73. PMID: 31648427; PMCID: PMC7018298.