Category: Clinical Stones: PCNL
Introduction & Objective :
Our institute is a high volume stone centre. We performed 1200 – 1500 PCNL annually. We had developed a model to teach and master the trainee to learn PCNL during his tenure.
Aims and objectives: to teach residents PCNL with higher success.
BTSK model: First trainee will be acustomised to OT environment and instruments of PCNL for 1 month by observing surgeon doing PCNL for 50 cases. After that trainee will scrub and assist 200-300 cases. He will assist dilatation, stone fragmentation, retrieval and stent placement. Trainee will be allowed to put ureteric catheter after 300-350 cases and ask him to put it in upper calyx. Allow him to remove the stone for next 50-75 cases. After that he will perform stone fragmentation for 50-60 cases. By the end of his 1st year he will be allowed to dilate the tract under observation. After success in all these steps surgeon will puncture the system and will allow trainee to perform the whole surgery for 50 cases under observation. Then he will be allowed to puncture in dilated simple system for 50 cases followed by non dilated calyx puncture. Then he will be allowed to do independent PCNL, while consultant only observed his puncture and complete clearance status. He will be allowed to do upper calyx puncture after performing 50 cases independently. Subsequently he will perform PCNL in HSK, duplex system and mal-rotated kidney. Lastly we allowed him to do tubeless PCNL and Miniperc PCNL during 3rd year of training and after performing 200 cases independently.
Every trainee had assisted 600-650 PCNL and performed 275-350 PCNL. Complications rate was around 8.3 to 9% in all cases performed by trainees. 60% were of Clavien Dindo grade 1, 31% were of grade 2 and only 9% were of grade 3 among all the complications occur. Inability to puncture was seen in 4% of cases. Complete clearance was 94% and was always checked by senior consultant at end of procedure.
It is a good model to master trainees in PCNL over period of his training. But limitations are there as many centres do not have such huge amount of work. Multi centric validation is needed.
Pratikkumar Shah– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India
Gopesh Panwar– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India
Pankaj Dholaria– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India
Sunil Moteria– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India