The Impact of Endourological Experience on Flexible Ureteroscopy Outcomes and Performance at Different Levels of Expertise: Retrospective Multifactorial Analysis

Abstract

Introduction: The aim of this study was to analyze the influence of residents' participation in flexible ureteroscopy (fURS) on intra-and postoperative outcomes. Materials and Methods: Intra-and postoperative parameters were compared in a retrospective monocentric setting between 3 groups: "resident group" (47 cases) for surgeries performed by experienced residents alone, "consultant group" (245 cases) for surgeries performed by consultants alone, "resident plus consultant group" (124 cases) for training surgeries between September 2013 and June 2017. Results: Patients operated by residents alone had a significantly smaller median kidney stone diameter (5.0 vs. 7.0 mm for "consultant group" and 6.0 mm for "resident plus consultant group," p = 0.011), shorter operating time (median 47.0 vs. 63.0 and 77.0 min, p < 0.001) and fluoroscopy time (median 39.0 vs. 69.5 and 89.0 s, p < 0.001), as well as shorter postoperative hospital stay (p = 0.013). The laser application rate was the smallest in the "resident group" (10.64 vs. 31.43 and 29.84%, p = 0.009). Univariate analysis revealed no relevant differences regarding flexible ureteroscope defect rate, postoperative stone-free rate, or ≥2 Clavien-Dindo classification complications between the groups (p > 0.05). Conclusion: A proper case selection of less complicated cases, especially without laser application, could balance the experience deficit of the residents. fURS can be incorporated as a part of residents' training without an impact on fURS device defect rate or clinical outcomes.

Efficiency and Clinical Outcomes of Moses Technology with Flexible Ureteroscopic Laser Lithotripsy for Treatment of Renal Calculus

“…Following the development of new equipment and methods, URL has improved rapidly during recent decades. The application of flexible ureteroscopy and improvements in the quality of intraoperative imaging has reduced the operating time and made these procedures more convenient [4][5][6][7].…”

The dilemma of 12/14F ureteral access sheath (UAS) usage: a case control study

“…A relevant percentage (ca. 40%) of fURS is being performed at our department by residents in training [ 14 ]. fURS with UAS is in our opinion more challenging due to insertion-related issues, less intuitive orientation in calyceal system in a low-pressure environment and continuous attention to a correct position of UAS during repeated stone extractions.…”

“…The details of the fURS procedure have already been described in our previous manuscripts [ 13 , 14 ]. The patients consented to fURS at least 24 h preoperatively.…”

Flexible Ureterorenoscopy under Spinal Anesthesia: Focus on Technique, Results, Complications, and Patients’ Satisfaction from a Large Series

“…SA allows patients themselves to control the length of apnea periods, thus reducing the risk of hypercapnea. In addition, experienced surgeons can predict and adapt to respiratory excursion: sometimes, breathing movements can be even used to achieve valid lithotripsy, staying still with the scope and letting the stone move in front of it [18]. On the other hand, patients are asked, at the beginning of the procedure, to promptly warn the surgeon in case they feel the need of moving, coughing, or complaining of pain during SA: thus, the surgeon can wait still, while the patient is assisted by the anesthesiologist.…”