The Learning Curve in the Training of Percutaneous Nephrolithotomy

Tanrıverdi, Orhan; Boylu, Uğur; Kendirci, Muammer; Kadıhasanoğlu, Mustafa; Horasanlı, Kaya; Miroğlu, Cengiz

doi:10.1016/j.eururo.2007.01.001

Cited by 153 publications

(91 citation statements)

References 16 publications

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“…This surgery may even lead to nephrectomy. Thus, the aforementioned procedure is difficult and requires great skill [1][2][3][4][5][6][7][8][9]. In this study, the operations started from simple surgical cases (depending on the calculus type) to help these surgeons gain experience.…”

Section: Discussionmentioning

confidence: 99%

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Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Zeng²,

You

et al. 2014

Indian J Surg

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Strict selection of patients for minimally invasive percutaneous nephrolithotomy could effectively improve the success rate of surgery. This study aimed to understand the required skills and the efficacy of mini-PCNL in the treatment of five types of upper ureteral calculi. Data collected after X-ray analysis and B mode ultrasound from 633 patients with upper ureteral and renal pelvis calculi who underwent B ultrasound-guided lithotomy was reviewed, including the following: type I, upper ureteral or renal pelvis calculi with moderate hydronephrosis (154 cases); type II, upper ureteral or renal pelvis calculi with severe hydronephrosis (157 cases); type III, upper ureteral or renal pelvis calculi without hydronephrosis (61 cases); type IV, renal pelvis calculi, one or two renal calyx calculi (206 cases); and type V, renal staghorn calculi (55 cases). Operations on 611 cases were successful. The treatment method for five patients was converted to open surgery. Twelve cases were treated by indwelling double-J tube retrocatheterization and extracorporeal shock wave lithotripsy. Five patients gave up the treatment. The rate of calculus clearance was 82.3 %, and the rate of residual calculus was 17.6 %. Selective renal artery embolization was performed in nine cases. Hydropneumothorax occurred in nine cases. No intestinal fistula occurred, and no patient had to undergo nephrectomy. The difficulty and the curative effect of the operation were different because the types of calculi varied. Selection of the procedure based on the different types of calculi could effectively improve the success rate of the procedure, reduce complications, and shorten the learning curve.

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Section: Discussionmentioning

confidence: 99%

“…However, the difficulty of the operation may vary, and the learning curve may be longer because calculi are of different types [1][2][3]. Serious complications such as intraoperative bleeding and nephrectomy have also been reported [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Zeng²,

You

et al. 2014

Indian J Surg

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“…İlk 50 vakada başarı oranı %80 iken son 50 vakada başarı oranı %94'e kadar çıkmaktadır. Tanrıverdi ve arkadaşları [9] cerrahi yeterliliğe 60 vaka ile ulaşıldığını ve 60 vakadan sonra operasyon süresinde azalma olmadığını saptamışlardır. İnterkostal girişlerin komplikasyon üzerinde etkisi olmakla beraber başarı üzerine etkileri yoktur.…”

Section: Discussionunclassified

Factors Affecting Success and Complication of Percutaneous Nephrolithotomy

Yalcinkaya¹,

Yücel²,

Hatipoğlu³

et al. 2012

Ann Clin Anal Med

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ÖzetAmaç: Perkutan nefrolitotomi ameliyatları 2 cm�den büyük böbrek taşları için ilk seçenek olup yüksek başarı ile uygulanmasına karşın ciddi komplikasyonlara yol açabilmektedir. Çalışmamızda başarı ve komplikasyonları etkileyen faktörleri inceledik. Gereç ve Yöntem: Temmuz 2004 ile Ağustos 2007 tarihleri arasında 176 hastaya (102 Erkek/74 Kadın) PNL operasyonu uygulandı. 9 hastaya bilateral böbrek taşı nedeniyle iki ayrı seansta PNL uygulandı. Perkü-tan giriş hasta yüzüstü yatar pozisyonda iken yapıldı. Hastaların verileri toplanarak başarı ve komplikasyona etki eden faktörler incelendi. Bulgular: Olguların yaş ortalaması 47.6±10,7 (17�76 yıl, median=47) yıl olarak saptandı. Postoperatif birinci günde çekilen direkt grafilerde tam başarı %77.8 oranında saptandı. Böbrek taşı kalan hastaların %19.6�sına uygulanan ek tedavi sonrası başarı oran %87�ye yükseldi. Başarı oranı kompleks taşlar için %83.1, basit taşlar için %89.4 olarak bulundu (p<0,001). Sonuç olarak, çalışmamız-da taşın boyutunun ve lokalizasyonunun, giriş sayısının, cerrahi tecrübenin ve ek tedavi gereksiniminin başarı oranlarını istatistiksel anlamlı olarak etkileyen faktörler olduğu saptandı. Hastaların %14.1�inde majör, %17.8�inde ise minör komplikasyonlar saptandı. Postoperatif dönemde bir hasta kaybedildi. Major komplikasyon olarak olguların 15�inde transfüzyon gerektiren kanama, 2 vakada komşu organ yaralanması, 2 vakada malekot kateterin çıkma-ması, bir vakada nonfonksiyone böbrek saptandı. Taş yükünün fazla olması ve kompleks taşlar, giriş yeri ve birden fazla giriş komplikasyon oranlarını etkileyen bağımsız faktörler olarak saptandı. Sonuç: Taş boyutu ve lokalizasyonu, uygulanan giriş sayısı, ek tedavi gereksinimi ve cerrahi tecrübe PNL işlemin-de başarıyı etkileyen faktörler olarak sıralanabilir. Özellikle tecrübeli ellerde düşük komplikasyon oranları ile yüksek başarılı sonuçlar almak mümkündür. Anahtar KelimelerPerkutan Nefrolitotomi; Başarı; Komplikasyon Abstract Aim: Percutaneous nephrolithotomy (PNL) is the first choice renal stones especially larger than 2 cm, and high success rates can be achieved after PNL. But several severe complications may be occurred. In this study, factors which affect the success rate and complications were investigated. Material and Method: Between July 2004 and August 2007, 176 patients (102 men/74 women) underwent PNL operation. Because of the bilateral renal stones PNL was performed in two separate sessions of 9 patients. Percutaneous access was doing in prone position. Factors affecting the success and complication data were collected. Results: Mean age was 47.6±10,7 (17%uFFFD76 year, median=47). Complete success rate was detected 77.8% with the direct X-rays taken in the first postoperative day. The success rate was up to 87% after the additional post-treatment therapy. Success rates were 83.1% for complex stones and 89.4% for simple stones (p <0.001). Stone size and location, percutaneous access number, surgical experience and the need for additional treatment as factors affecting the success rates we...

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“…When one considers, also, the steep learning curve associated with training in PCNL and the fact that more than 60 cases are required to achieve competence in the technique, 1,2 we feel these data clearly demonstrate the need to centralise the management of upper tract stones to units that can offer all forms of treatment with all methods of stone destruction.…”

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confidence: 99%

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The Learning Curve in the Training of Percutaneous Nephrolithotomy

Cited by 153 publications

References 16 publications

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy

Factors Affecting Success and Complication of Percutaneous Nephrolithotomy

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