Introduction: The last decade saw a significant introduction of minimally invasive surgery into medical practice. Laparoscopy has even become the gold standard for some interventions. This has led to an increased demand for qualified specialists. The acquisition of laparoscopic surgery skills entrains a time investment both on part of the trainee and the instructor. The need for an accelerated development of specific psycho-motor perceptions which are a requirement for the execution of laparoscopic procedures, led to the establishment of virtual reality simulator training. For the first time in Bulgaria, in 2016, the Medical University of Varna introduced formal education via the way of virtual reality laparoscopic simulators. They permit the development of laparoscopic skills even at the level of a medical student. Aim: The aim of the article is to analyze the efficiency of existing virtual reality simulators and their application in laparoscopic surgery training. Materials and Methods: А systematic literature analysis was performed via the databases PubMed, Web of Science, Scopus and Google Scholar using various combinations of the following keywords: “simulation”, “virtual*”, “VR”, “laparoscopic*”, “surgery”, “education”, “LapMentor”, “LapSim”, for articles published in the past 10 years. The keywords were in combination with Boolean operators “and”, “or”. After a thorough review of all pertinent articles the most relevant publications were selected. Results: The electronic inquiry yielded 106 articles in total. After the application of suitable inclusion and exclusion criteria, 98 of them were deemed unfit, leaving 8 randomized control trials. To meet the inclusion criteria, the publications needed to be systemized random prospective studies regarding virtual reality simulators in laparoscopic surgery. Conclusion: Advancements in the field of surgery follow closely the introduction of new technologies. This leads to the need for a change of traditional surgery training practices. The need of laparoscopic surgery specialists becomes greater with every passing year. The new generation of virtual reality simulators provides a complete set of basic skill procedures and complete operative procedures. Due to their limitless repeatability, an expert level of proficiency is able to be reached in a relatively short period of time. The surgical community must take note of the practices that have already been adopted by aviation training and introduce mandatory laparoscopic surgery training programs, which all specialists must undergo before undertaking procedures in the operating theater.

A complex evaluation of colorectal cancer (CRC) in relation to screening, diagnosis, stage determination, prognosis, and treatment requires valuable biomarkers. The aim of this study was to measure selected biomarkers—uric acid (UA), lactate, Na⁺, Cl⁻, and osmolality—in CRC patients and to assess their diagnostic value to distinguish between CRC and healthy controls. Plasma lactate (2.21 ± 0.11 vs. 2.88 ± 0.19, p < 0.01), Na⁺ (130.79 ± 0.42 vs. 133.23 ± 0.25, p < 0.001), Cl⁻ (102.59 ± 0.45 vs. 103.94 ± 0.23, p < 0.01), and osmolality (266.44 ± 0.86 vs. 271.72 ± 0.62, p < 0.001) were found to be significantly lower in CRC patients as compared to the healthy controls group. Among them, with satisfactory diagnostic potential, were plasma Na⁺ concentrations and osmolality (AUCNa+ = 0.752, p < 0.0001; AUCosmolality = 0.757, p < 0.05), respectively. UA concentrations were detected at higher concentrations in CRC patients (333.67 ± 13.05 vs. 295.88 ± 13.78, p < 0.05). The results of this study contribute to the elucidation of molecular mechanisms of CRC pathogenesis and the role of studied metabolic parameters in this process. Plasma uric acid, lactate, and osmolality parameters can be used for screening and monitoring colorectal cancer. Further studies are required to elucidate the molecular mechanisms of their action in cancer development. The action of circulating plasma lactate may be different from those locally produced in the tumor microenvironment.