Modular training for percutaneous nephrolithotripsy: The safe way to go

Abstract

Objectives should be describe a modular training scheme (MTS) which aims to provide training in percutaneous nephrolithotripsy (PCNL) and ensure the safety of the patients.Subjects and methodsTwo trainees with no experience in PCNL attended the MTS under the supervision of an experienced mentor. The MTS included five modules, comprising an initial animal laboratory course (using pigs), to acquire basic skills (Module 1), and Modules 2–5 included making the puncture, tract dilatation, single-stone and large-stone management in clinical cases, respectively. Each participant progressed from one module to the next under constant mentoring and evaluation by the mentor. When the trainees completed the MTS they proceeded to perform 60 PCNL procedures independently while the mentor performed 25 for comparison purposes. A global rating scale was used for the objective evaluation of the trainees. Peri-operative variables were recorded and statistically compared as appropriate. Statistical significance was defined as P < 0.05.ResultsOne pig and 16 patients, and two pigs and 22 patients, were necessary to complete the MTS by each subject. There were no significant differences among the characteristics of the independently performed operations. The duration of surgery and fluoroscopy achieved a plateau similar to those of the mentor after ≈ 30 patients. The decrease in haemoglobin level, stone-free and complication rates in the patients were similar among the two trainees and the mentor. The complication rate of the trainees and the mentor never exceeded 13.3%.ConclusionThe MTS successfully combined animal and stepwise clinical training based on a standardised technique and objective evaluation.

Stepwise case selection using Guy's stone score reduces complications during percutaneous nephrolithotomy training

“…[516171822] Moreover, in our study, most major complication events happened when higher grades of calculus complexity were tackled early in the learning curve (especially during first fifty cases) even though expert help was always available. Furthermore, we found that for both traditional and stepwise training groups the skill of the surgeon continued to grow, and complete clearance with no major complications was achieved in all cases of GSS 1 and 2 grade calculi which were operated beyond thirty and sixty case mark respectively.…”

“…[5161718] A common theme observed was that surgical competence could be achieved at around sixty patients, whereas excellence is achieved after slightly more than 100 cases. Use of ultrasound guidance suggested no different results.…”

“…where they have divided PCNL training into five modules which starts with initial animal laboratory course and progresses to step wise acquisition of PCNL skills culminating to single stone and large stone management in clinical cases. [16] They reported the results where trainees achieved operative and fluoroscopy time and complications similar to mentor after thirty cases.…”

Simulation for Percutaneous Renal Access: Where Are We?

“…[23][24][25][26] Only one study reported the use of anesthetized live pigs as module 1 of the Modular Training Scheme, which included renal puncture, tract dilatation using the Amplatz dilators, and orientation with the nephroscope in a live pig. 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.…”

A novel biological model for training in percutaneous renal access

“…Earp [14] used porcine kidney encased in a foam layer. Kallidonis et al [15] and Mishra et al [16] studied the live anaesthetised pig as a model for PCNL training.…”