Assessment of percutaneous renal access skills during Urology Objective Structured Clinical Examinations (OSCE)

Abstract

Introduction: The first objective was to assess percutaneous renal access (PCA) skills of urology postgraduate trainees (PGTs) during the Objective Structured Clinical Examinations (OSCEs). The second objective was to determine whether previous experience with percutaneous nephrolithotomy (PCNL) improved performance. Methods: After obtaining ethics approval, we recruited PGTs from two urology programs in Quebec between postgraduate years (PGY-3 to PGY-5). Each trainee was asked to answer a short questionnaire regarding previous experience in endourologic procedures. After a 3-minute orientation on the PERC Mentor simulator (Simbionix, Cleveland, OH), each trainee was asked to perform task 4, where they had to correctly access all of the renal calyces and pop the balloons in a normal left kidney model. We collected and analyzed data from the questionnaire and the performance report generated by the simulator. Results: In total, 13 PGTs participated in this study. PGTs had performed a median of 200 (range: 50-1000) cystoscopies, 50 (range: 10-125) TURBTs, 30 (range: 0-100) TURPs, 5 (range: 0-50) laser prostatectomies, and 50 (range: 2-125) ureteroscopies prior to this OSCE. PGTs with previous PCNL experience (8/13) had performed a mean of 18.6 ± 6.3 PCNLs. PGTs with previous PCNL experience performed significantly better in terms of shorter fluoroscopy time (10 ± 1.5 vs. 5.1 ± 0.7 min; p = 0.04), fewer attempts required for successful puncture of the pelvi-calyceal system (PCS) (21 ± 2.3 vs. 13 ± 1.8; p = 0.02), and had significantly lower complications in terms of fewer infundibular injury (7.4 ± 1.5 vs. 2 ± 0.4; p = 0.004) and fewer PCS perforations (11 ± 1.7 vs. 4.5 ± 1.2; p = 0.01). Conclusion: It is feasible to use the PERC Mentor simulator during OSCEs to assess PCA skills of urology PGTs. PGTs who had previous PCNL experience performed significantly better with fewer complications.

Simulation for Percutaneous Renal Access: Where Are We?

“…Few studies were found on assessment of PCA skills. 12,13 The biological bench models used porcine or bovine kidneys wrapped within foam, 14 foam in a mannequin, 15 silicone, 16 chicken carcass, 17,18 full-thickness skin flap, 19,20 or additional subcutaneous fascia, muscle, 21 and ribs. 22 Other nonbiological bench models used prototyping or 3D printing.…”

“…27 The PERC MentorÔ (Simbionix, Cleveland, OH) was the only VR simulator that has been validated for training and assessment of PCA skills. 12,13,[28][29][30][31] However, none of these studies assessed the educational impact of PCA simulators in terms of transferring PCA skills from the benchtop to the OR. Furthermore, most of these studies did not address the validity and the cost of these simulators.…”

“…[53][54][55] Simulators used for assessment of PCA skills include human cadavers, live animals, and VR simulators to simulate human patients. 56,57 In a recent study by Noureldin et al, 12,13 the PERC Mentor simulator was incorporated into urology objective structured clinical examinations to assess PCA skills of PGTs. PGTs with previous PCA experience had performed the PCA with significantly shorter FT (5.1 -0.7 vs 10 -1.5; p = 0.04), fewer infundibular injuries (2 -0.4 vs 7.4 -1.5; p = 0.004), fewer PCS perforations (4.5 -1.2 vs 11 -1.7; p = 0.01), and fewer attempts to puncture the PCS (13 -1.8 vs 21 -2.3; p = 0.02) when compared with PGTs without previous PCA experience, respectively.…”

“…PGTs with previous PCA experience had performed the PCA with significantly shorter FT (5.1 -0.7 vs 10 -1.5; p = 0.04), fewer infundibular injuries (2 -0.4 vs 7.4 -1.5; p = 0.004), fewer PCS perforations (4.5 -1.2 vs 11 -1.7; p = 0.01), and fewer attempts to puncture the PCS (13 -1.8 vs 21 -2.3; p = 0.02) when compared with PGTs without previous PCA experience, respectively. 12 Since the 2011 Austria…”

The surgical outcome of percutaneous nephrolithotomy based on principle of right triangle for renal access with fix C-arm and no the contrast

“…Such surgery is sаfe when treаting lаrge renаl stones [2]. One of the most importаnt steps of PCNL is gаining аccess to the renаl collecting system before dilаtаtion [3]. This step is frequently аssociаted with complicаtions [4].…”