The learning curve for access creation in solo ultrasonography-guided percutaneous nephrolithotomy and the associated skills

Ye, Weimin; Rao, Ting; Li, Xing; Ruan, Yuan; Yuan, Run; Li, Chenglong; Li, Haoyong; Fan, Chengming

doi:10.1007/s11255-016-1492-8

Cited by 22 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The SFR increased with experience and achieved an overall of 75% for all the procedures. Similar findings were reported by Yu et al [47], their study concluded that 60 procedures are necessary for proper USGA PCNL experience, 120 represent excellent performance and nearly perfect results are obtained after 180 procedures.…”

Section: Resultssupporting

confidence: 88%

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Resultssupporting

confidence: 88%

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

et al. 2018

View full text Add to dashboard Cite

show abstract

“…These changes were within reasonable limits (4.4 to 1.3 min and 2.1 to 1.2 attempts). The increase in the stone-free rate from 68.3% to 93.3% showed a typical learning curve problem [20]. The authors assume that competence and excellence in UPNL is achieved after 60 and 120 operations, respectively.…”

Section: Stone Scores and Learning Curvesmentioning

confidence: 95%

“…Classical publications on FPNL learning curves show that operating room (OR) time-related competence is reached after 60 cases, with acceptable radiation doses after 120 cases. Some recent clinical papers dealt with learning curves for UP [18], FPNL [19], UPNL [20] and FUPNL [21].…”

Section: Stone Scores and Learning Curvesmentioning

confidence: 99%

Percutaneous nephrolithotomy – the puncture

Alken

2021

BJU International

View full text Add to dashboard Cite

ObjectiveTo determine what importance is given to the puncture and assistive technologies in percutaneous nephrolithotomy (PNL) in the current urological literature. MethodsPubMed was searched for English publications and reviews for the keywords: 'percutaneous nephrolithotomy', 'percutaneous nephrostomy', 'puncture'. The search was limited to the last 5 years, January 2016 until February 2021. Based on 183 abstracts, 121 publications were selected, read, and reviewed. References, older or seminal papers were read and cited if they contributed to a better understanding. A total of 198 references form the basis of this narrative review. ResultsThe puncture is frequently referred to as the most crucial part of PNL. In contrast, the influence of the puncture on the failure rate of PNL and the specific puncture-related complications seems to be low in the single-digit percentage range. However, there are no universally accepted definitions and standards measuring the quality of puncture. Consequently, the impact of the puncture on general PNL complications, on stone scores predicting success rates and on learning curves evaluating surgeons' performance have not been systematically studied. Assistive technologies rely on fluoroscopy and ultrasonography, the latter of which is becoming the preferred imaging modality for monitoring the entire procedure. Needle bending, a problem relevant to all puncture techniques, is not addressed in the urological literature. ConclusionsThe importance attached to puncture in PNL in the current urological literature is subjectively high but objectively low. Some basics of puncture are not well understood in urology. Disciplines other than urology are more actively involved in the development of puncture techniques.

show abstract

“…Residual calculi and severe hemorrhage are the two major challenges to implementing tubeless PCNL. Avoiding intraoperative bleeding depends greatly on the experience and skill of the surgeon (18). Therefore, we recommend that tubeless PCNL should only be carried out by experienced surgeons.…”

Section: Skilled and Gentle Operation To Avoid Complicationsmentioning

confidence: 99%

Case selection and implementation of tubeless percutaneous nephrolithotomy

Mao¹,

Huang²,

Li³

et al. 2021

Transl Androl Urol

View full text Add to dashboard Cite

Background: The tubeless percutaneous nephrolithotomy (PCNL) was proposed to eliminate the side effects of the nephrostomy tube in recent years, such as pain, channel infection, postoperative bleeding, and longer hospital stay. But there is neither clinical guidelines nor consensus about tubeless PCNL in clinical practice. The study is aimed to how to implement the tubeless PCNL step by step, including case selection preoperatively, improving the technique of the surgeon, making the correct decisions at the end of the procedure, which had not been previously examined.Methods: From January 2017 to March 2018, 364 consecutive patients requiring PCNL were comprehensively analyzed preoperatively and patients were selected for scheduled tubeless PCNL based on four aspects. The selected patients were divided into two groups according to whether the nephrostomy tube was finally placed. The mean operative time, intraoperative blood loss, stone clearance rate, visual pain score, postoperative hospitalization days and perioperative complications were all evaluated.Results: Based on the preoperative evaluation, 42 patients were selected for tubeless PCNL, among which there were finally 37 cases of completed tubeless PCNL. Compared with patients undergoing conventional PCNL, there were not statistical differences in the mean operative time (P=0.207) or intraoperative blood loss (P=0.450) in the tubeless group. Stone clearance rate was 100% in both groups. The visual pain scores in the tubeless PCNL group were lower on operation day (P=0.029), first postoperative day (P<0.001) and the day of discharge (P=0.025). The postoperative hospitalization for the tubeless PCNL group was shorter than that of the control group (P<0.001). No significant difference in grade 1 complications was seen (P=0.424), and no grade 2 or higher complications were observed in either group. Conclusions:Postoperative pain was significantly relieved and postoperative hospitalization was significantly shortened in the tubeless PCNL group. Tubeless PCNL is safe if patients are carefully selected using four criteria before operation, attention is paid to four key points and five confirmations are made during operation.

show abstract

The learning curve for access creation in solo ultrasonography-guided percutaneous nephrolithotomy and the associated skills

Cited by 22 publications

References 19 publications

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review

Percutaneous nephrolithotomy – the puncture

Case selection and implementation of tubeless percutaneous nephrolithotomy

Contact Info

Product

Resources

About