A training simulator for ultrasound-guided percutaneous nephrostomy insertion

Abstract

ABSTRACT. Increasing trainee numbers and changes to working patterns have resulted in a scarcity of training opportunities for training-grade doctors wishing to learn nephrostomy tube insertion techniques. A method of introducing trainees to the skills required to perform percutaneous nephrostomy in a safe, non-threatening environment, without risk to patients, is desirable. Commercial and biological nephrostomy phantoms are available, but they are expensive and not widely available, and a cheap, safe, valid alternative is desirable. We describe a simple technique for producing a gelatin-based phantom, which we suggest has face and content simulator validity. The use of this nephrostomy phantom could optimise existing clinical training opportunities through familiarisation with nephrostomy technique and equipment, and development of the psychomotor skills required for successful nephrostomy insertion prior to undertaking supervised procedures on patients. Skills in ultrasound-guided percutaneous nephrostomy insertion are desirable for trainee radiologists. Nephrostomy is often the method of choice for emergency decompression of an obstructed renal system, particularly in the presence of urinary infection. This intervention is frequently required as an "on-call" procedure. Moreover, the skills required for ultrasound needle guidance and the Seldinger technique are crosstransferable, being of use in the drainage of collections elsewhere in the body and in the performance of ultrasound-guided biopsies. Preferably, trainees should acquire these skills in a safe, non-threatening environment, without patient risk.Commercial nephrostomy phantoms are available and biological phantoms have been described [1,2], but both of these have disadvantages (including cost and hygiene considerations, respectively). Gelatin-based phantoms have been described for developing ultrasound-guided biopsy technique [3,4], but these do not facilitate the complex procedural sequence required to insert a drain into a dilated pelvicalyceal system. A gelatin-based system has recently been described that allows ultrasound-guided puncture of a simulated pelvicalyceal system [5], but the costs and complexity of production may be prohibitive for routine use by trainees. We therefore describe a cheap and relatively simple technique, adapted from previously described methodology [3,4], for producing a gelatinbased phantom that permits ultrasound-guided puncture, wire insertion, serial dilatation and drainage of a fluid-filled cavity that simulates the dilated collecting system of a hydronephrotic kidney.

A prospective study integrating a curriculum of interventional radiology in undergraduate education: a tetra-core simulation model

“…A unique aspect of our course was the implementation of an in-vivo porcine simulation module. With the exception of the in-vivo module, many of the simulation stations were inspired from previous studies (Rock et al 2010;Sideris et al 2015). This was perceived by students as 'inspiring', offering the 'best possible insight into IR'.…”

How Can We Improve the Delivery of Urology Teaching to Medical Students Using Modern Educational Techniques?

“…For inspiration, we only need to look at companies like Peninsula Radiology Academy™ who have made a renal pelvicalyceal system that responds to fluid, akin to a hydronephrotic kidney. 6 During times where some universities have completely abandoned dissection, anatomical models may provide the best solution.

Figure 1 A prostatectomy model was used to teach medical students.

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Simulation: Moving from Technology Challenge to Human Factors Success

“…Fixed models can be inexpensive and useful to train a range of straightforward manipulative skills [10], but their anatomic detail is difficult to alter, lacking natural anatomical variability, and they generally suffer from wear and tear. Currently topical are computer-based, virtual reality, augmented reality, and hybrid technologies that use human-computer interface devices and two-or three-dimensional video screens to replicate the visual, spatial, and tactile elements of procedures in patients [11][12][13].…”