New ex-vivo organ model for percutaneous renal surgery

Abstract

Objectives: Percutaneous Renal Surgery (PRS) is a demanding procedure and success is mostly hampered by the lacking of training facilities. Thus, the purpose of the study was to evaluate a significantly improved pre-existing porcine kidneytraining model for percutaneous renal access and PRS. Materials and Methods: A biologic training model using porcine kidneys coated by a full-thickness porcine skin flap was prepared. The ureter was dissected, stones were placed into the collecting system using an 18F amplatz sheath, and a catheter was placed in the ureter for further irrigation with saline or contrast medium. For initial training with an easy access, a standard guide-wire was inserted in the ureter through the renal parenchyma. The kidney was punctured with radiographic or ultrasound guidance. Minimally invasive percutaneous nephrolithotomy (MIP) was then tested using the model under radiographic or ultrasound guidance. The model was then evaluated in MIP training courses, which are regularly held at The Hannover Medical School. Results: All trainees were urologists with experience in endourologic surgery but lacked practice in PRS. In conclusion, all 36 participants attained access to the collecting system using models with readily placed guide-wires. Subsequently, PRS was successful in all cases. Percutaneous puncture under ultrasound guidance and following intrarenal surgery was successful in 30 (83.3%) cases. Therefore, all participants rated the model useful for simulating percutaneous renal surgery. Conclusions: This new porcine kidney model is easy to build and is made cost effective by using readily available material. Moreover, it provides realistic and reproducible training model for PRS. The "organ" model mimics the retroperitoneum by having a full-thickness skin flap with a layer of subcutaneous fatty tissue.

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.…”

A novel biological model for training in percutaneous renal access

“…Hammond et al [9] and Häcker et al [10] used a porcine kidney in a chicken carcass. Zhang et al [11], Qiu et al [12] and Imkamp et al [13] used porcine kidney encased in skin or tissue flaps. Earp [14] used porcine kidney encased in a foam layer.…”

Modular training for percutaneous nephrolithotripsy: The safe way to go

“…Currently, there are few reports of structured training schemes [3] . A structured training programme, including acquiring technical and cognitive skills combined with clinical training under continuous mentoring and controlled conditions which ensure the safety of the patients, has not been proposed [2] , [3] , [5] , [6] , [10] , [11] , [12] , [13] . Structured training schemes such as the MTS have been described for laparoscopy [14] , [15] , [16] .…”