No abstract

(Rev Med Chile 2014; 142: 1136-1141

Introduction:The role of hemostatic agents as an adjunct for closure of the nephrostomy tract in tubeless percutaneous surgery (tubeless percutaneous nephrolithotomy [tPNL]) has been previously evaluated, observing a potential benefit in terms of reduced bleeding and urinary leakage. We assessed the rate of postoperative complications after the use of hemostatic agents for sealing the nephrostomy tract in patients undergoing tPNL at our institution.Subjects and Methods:We performed a retrospective analysis of 52 consecutive patients undergoing tPNL at our center between January 2010 and December 2013. No substance was placed within the tract in 25 patients (Group 1). A cylinder of Surgicel® in addition to 1 unit of Gelita® were placed within the access tract in 27 patients (Group 2). We accounted for demographic variables, stone size, operative time, postoperative pain, development of hematoma, postoperative hematocrit drop, urinary leakage, residual lithiasis, and hospital stay length.Results:Age and sex differed significantly between the two groups (P = 0.0002 and P = 0.048 respectively). However, there were no significant differences in terms of body mass index and stone burden. No significant differences between groups were found with regards to operative time, postoperative hematocrit drop, postoperative pain and presence of residual lithiasis.Conclusion:The use of Gelita® and Surgicel® as hemostatic agents in tPNL is safe, but we were not able to demonstrate any significant benefit in terms of postoperative morbidity after comparing the use of these agents in tPNL. We concluded that the uses of hemostatic agents needed to be evaluated in prospective randomized trials to define its benefits.

We present a prospective study assessing the iPerc performance of 30 urologists with an experience of less than 5 in vivo PCNL procedures (14 residents and 16 attendings in practice). Participants were scored before and after 20 attempts of puncture in our percutaneous access model. The evaluated parameters included KAT, ERT, number of angle-of-vision shifts and number of needle adjustments at 0 and 30 degrees.RESULTS: By the end of the training, the time required to complete the evaluated tasks decreased significantly: KAT (figure 1) improved from a median of 148 to 77 seconds (p¼0.000) and the ERT (figure 2) improved from a median of 101.5 to 45.5 seconds (p¼0.000), the overall results are displayed on table 1.CONCLUSIONS: Training in the iPerc model simulates the challenges a surgeon faces during the performance of PCNL procedures, improving ERT and KAT among users. This is a safe and effective training device that neither requires the use of laboratory animals nor radiation exposure.