Percutaneous Renal Access: The Learning Curve of a Simplified Approach

Negrete-Pulido, O; Molina-Torres, Marnes; Castaño‐Tostado, Eduardo; Loske, Achim M.; Gutiérrez-Aceves, Jorge

doi:10.1089/end.2009.0210

Cited by 19 publications

(9 citation statements)

References 11 publications

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“…A total of six studies evaluated the learning curve for PCNL and renal access (Table ). In addition to total OT, complications and LOS the variables measured included stone extraction rate, stone‐free rate (SFR) and fluoroscopy time.…”

Section: Resultsmentioning

confidence: 99%

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Learning curves for urological procedures: a systematic review

et al. 2013

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Objective• To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. Patient and Methods• The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011.• Studies pertaining to learning curves of urological procedures were included.• Two reviewers independently identified potentially relevant articles.• Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. Results• Forty-four studies described the learning curve for different urological procedures.• The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases.• The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number.• Robot-assisted radical cystectomy has a documented learning curve of 16-30 cases, depending on which outcome variable is measured.• Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs. Conclusions• The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency.• The complexities associated with defining procedural competence are vast.• The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures.

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Section: Resultsmentioning

confidence: 99%

“…A similar study by Negrete‐Pulido et al. reviewed 92 percutaneous renal accesses in patients with renal stones or PUJ obstruction performed by an endourology fellow without previous experience in percutaneous surgery. The rate of success increased from 82.5 to 97.6% after the first 40 punctures.…”

Section: Resultsmentioning

confidence: 99%

Learning curves for urological procedures: a systematic review

et al. 2013

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“…Similar results were reported by Tanriverdi et al [44], who found that approximately 60 procedures are necessary for a non-experienced urologist to gain competence in FGA PCNL, as after this amount there was no significant drop in operating time or radiation exposure. More recent data suggest that at least 50 procedures of FGA PCNL are necessary in order to achieve reliable skills in accessing the collecting system [45].…”

Section: Resultsmentioning

confidence: 99%

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

et al. 2018

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Nowadays percutaneous nephrolithotomy (PCNL) is the standard of care for renal staghorn calculus or large (>20 mm) pelvic or caliceal stones, as well as for the failure of other treatment options. This review aims to evaluate the contemporary use of ultrasound imaging in PCNL, by comparing it to conventional fluoroscopy, reviewing data regarding the complication and success rate of nephrostomy tract creation and stone free rate (SFR), as well as data concerning the learning curve for these procedures and cost indicators. The evidence acquired shows that the ultrasound guided access (USGA) is a comparable method with the classic fluoroscopic guided access (FGA), with a similar safety profile, with a significant reduction in radiation exposure, up to radiation free complete PCNL. USGA PCNL seems to lead to decreased bleeding and need for transfusion, especially when the Doppler mode is used, and also to a slightly higher SFR than conventional FGA PCNL. USGA PCNL reduces the overall costs of the procedure by about 30% and can be safely learnt and performed by urologists. For an experienced endourologist, familiar withFGA PCNL, the learning curve for shifting to USGA PCNL is of approximately 20 procedures.

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“…Many studies defined the learning curve for PCNL, jointly suggesting that at least 50 to 60 procedures are needed to acquire reliable competence in obtaining access to the kidney and a success rate between 82.5% and 97.6%. 4,5 Although salvage PCNL data on its safety and cogency, after previous unsuccessful PCNL, are available, 2 this is not yet for salvage ECIRS although its effectiveness has already been demonstrated as primary procedure. 6,7 We wanted to provide ECIRS feasibility in a salvage setting after previous failed PCNL.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Safety and Feasibility of Salvage Endoscopic Combined Intrarenal Surgery in Embolized Kidney

Benincasa

Nicolosi

Lughezzani

et al. 2016

Journal of Endourology Case Reports

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Background: Although endoscopic combined intrarenal surgery (ECIRS) is well established as primary approach to complex lithiasis, no evidences are still available on its use in salvage context.Case Presentation: A male patient, of 55 years of age, underwent many unsuccessful surgical procedures to treat large and multiple right kidney stones, including percutaneous nephrolithotomy (PCNL). The latter was complicated by severe postoperative hemorrhage, managed with super-selective renal artery embolization (SRAE). Therefore he came to our institution to achieve a complete resolution of the urolithiasis. Preoperative evaluation included CT scan and renal scintigraphy to establish kidney and stone morphologic features and residual renal function. Salvage ECIRS was performed and postoperative assessment showed a complete resolution of lithiasis and absence of renal function impairment.Conclusion: To our knowledge, this is the first case of salvage ECIRS reported in literature after previous failed PCNL. Even after SRAE, this procedure appears as safe and as efficacious as standard salvage PCNL when performed by experienced hands.

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Percutaneous Renal Access: The Learning Curve of a Simplified Approach

Abstract: The fluoroscopy-guided approach used in this study is an effective and reproducible technique. Our analysis revealed that at least 50 procedures are needed to acquire reliable competence in obtaining access to the kidney.

Cited by 19 publications

References 11 publications

Learning curves for urological procedures: a systematic review

Learning curves for urological procedures: a systematic review

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

Safety and Feasibility of Salvage Endoscopic Combined Intrarenal Surgery in Embolized Kidney

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