Residency Training in Percutaneous Renal Access: Does It Affect Urological Practice?

Lee, Courtney L.; Anderson, J. Kyle; Monga, Manoj

doi:10.1097/01.ju.0000104849.25168.6d

Cited by 70 publications

(30 citation statements)

References 6 publications

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“…This increasing role of flexible ureteroscopy has highlighted the training issues, because this procedure has a long learning curve and this learning process may increase the morbidity and cost of the surgery. For this reason, several training models have so far been developed to reduce the learning process of endourologic procedures [9,10,11,12,13,14]. However, all these reports have been published for percutaneous renal surgery training and to date no report has been published in the literature describing a model to aid urologists in RIRS.…”

Section: Discussionmentioning

confidence: 94%

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In vivo Porcine Model for Practicing Retrograde Intrarenal Surgery

et al. 2013

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Objectives: To examine the feasibility of retrograde intrarenal surgery (RIRS) in a porcine model. Materials and Methods: Female pigs (n = 3) were placed in a dorsal lithotomy position under general anesthesia, and stone material was inserted into the renal pelvis of the pigs. The bladder was entered with a cystoscope, and a 0.038-inch hydrophilic guidewire was passed into the renal pelvis. Following successful placement of the guidewire, a ureteral access sheath (9.5/11.5 Fr) was placed to allow for optimal visualization. A 7.5-Fr flexible ureteroscope (Karl Storz Flex-X2) and a 200-μm laser fiber were used for lithotripsy. When basketing was deemed necessary, zero-tipped nitinol stone baskets were used. Trainees then practiced all these manipulations on the model. Results: Urologists with moderate experience in advanced endourologic surgery were trained using thismodel. However, there weresome surgical difficulties due to the urinary system anatomy of the pig. Intravaginal location of the urethra, bladder neck location of the ureters, tight ureteric orifices, tortuous ureters, longitudinally elongated renal pelvis, narrow infundibulopelvic angle and shallow calices made the passage of the instruments and maneuverability of the flexible ureteroscope more difficult than in a human model. Conclusions: Despite some difficulties, our porcine model was very effective, because all the trainees successfully practiced the RIRS manipulations on this model.

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Section: Discussionmentioning

confidence: 94%

“…In the medical literature, several training models have been evaluated to date, consisting of different technical simulators and ex vivo or in vivo biological materials [9,10,11,12,13,14]. They concluded that an ideal training model needs to be realistic, commonly available and cost-effective.…”

Section: Discussionmentioning

confidence: 99%

In vivo Porcine Model for Practicing Retrograde Intrarenal Surgery

et al. 2013

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“…A perceived lack of skill is also among the most common reasons given by urologists for not achieving percutaneous renal access. 11 Implicit in this self-assessed lack of skill is the difficulty inherent in translating the 2-dimensional images of intraoperative fluoroscopy into the 3D anatomy of the renal collecting system. This challenging portion of the procedure is hindered by 1 He depicted the anterior calyces as medial and the posterior calyces as lateral.…”

Section: Discussionmentioning

confidence: 99%

Renal Calyceal Anatomy Characterization with 3-Dimensional In Vivo Computerized Tomography Imaging

et al. 2013

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Abbreviations and Acronyms 3DPurpose: Calyceal selection for percutaneous renal access is critical for safe, effective performance of percutaneous nephrolithotomy. Available anatomical evidence is contradictory and incomplete. We present detailed renal calyceal anatomy obtained from in vivo 3-dimentional computerized tomography renderings. Materials and Methods: A total of 60 computerized tomography urograms were randomly selected. The renal collecting system was isolated and 3-dimensional renderings were constructed. The primary plane of each calyceal group of 100 kidneys was determined. A coronal maximum intensity projection was used for simulated percutaneous access. The most inferior calyx was designated calyx 1. Moving superiorly, the subsequent calyces were designated calyx 2 and, when present, calyx 3. The surface rendering was rotated to assess the primary plane of the calyceal group and the orientation of the select calyx. Results: The primary plane of the upper pole calyceal group was mediolateral in 95% of kidneys and the primary plane of the lower pole calyceal group was anteroposterior in 95%. Calyx 2 was chosen in 90 of 97 simulations and it was appropriate in 92%. Calyx 3 was chosen in 7 simulations but it was appropriate in only 57%. Calyx 1 was not selected in any simulation and it was anteriorly oriented in 75% of kidneys. Conclusions: Appropriate lower pole calyceal access can be reliably accomplished with an understanding of the anatomical relationship between individual calyceal orientation and the primary plane of the calyceal group. Calyx 2 is most often appropriate for accessing the anteroposterior primary plane of the lower pole. Calyx 1 is most commonly oriented anterior.

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“…Cuando se realiza un entrenamiento formal en accesos percutáneos es más probable que después del entrenamiento, el médico proponga la nefrolitotricia percutánea como una opción a sus pacientes (27 vs Entrenamiento inanimado para acceso renal percutáneo 3 no la proponen argumentan que es un procedimiento que requiere mucha destreza en el acceso 31 . Existen pocos modelos para acceso renal percutáneo guiado y generalmente son biológicos, que requieren entrenamiento mediante repeticiones en riñones de cerdo 27,32,33 y exposición durante estas repeticiones a una dosis acumulada importante de radiación.…”

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Evaluación de 2 modelos inanimados para mejorar el tiempo de acceso renal percutáneo guiado por fluoroscopia

Maldonado-Alcaraz

Garcia

Serrano-Brambila

2015

Cirugía y Cirujanos

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Residency Training in Percutaneous Renal Access: Does It Affect Urological Practice?

Abstract: This study suggests a relationship between training in percutaneous renal access and subsequent use of percutaneous renal procedures in the urologist's practice. Emphasis should be placed on providing continuing education opportunities to maintain competency in this important technique.

Cited by 70 publications

References 6 publications

In vivo Porcine Model for Practicing Retrograde Intrarenal Surgery

In vivo Porcine Model for Practicing Retrograde Intrarenal Surgery

Renal Calyceal Anatomy Characterization with 3-Dimensional In Vivo Computerized Tomography Imaging

Evaluación de 2 modelos inanimados para mejorar el tiempo de acceso renal percutáneo guiado por fluoroscopia

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