Presentation Authors: Ralf Veys*, Pieter Verpoort, Ghent, Belgium, Carl Van Haute, Brussels, Belgium, Thomas Chi, San Francisco, CA, Thomas Tailly, Ghent, Belgium
Introduction: Percutaneous nephrolithotomy (PCNL) has been demonstrated to be a challenging procedure that requires specific training and a certain learning curve before reaching competence. As Thiel-embalmed cadavers (TEC) have been demonstrated to be a suitable training model for upper and lower tract endoscopy, we aimed to evaluate TEC as a training model for PCNL. In particular for ultrasound (US) guided, supine, endoscopic combined intrarenal surgery (ECIRS).
Methods: Thirteen urologists (9 experienced dedicated endo-urologists, 4 fellows/residents) performed an US guided supine ECIRS procedure on TEC to evaluate this model. Assessment was done by a questionnaire (Fig. 1) using a 5-point Likert scale. Descriptive statistical analysis was performed and results were graphically demonstrated in divergent bar graphs.
Results: US image was appreciated as lifelike in all aspects. Although distention of the collecting system was not ideal in all cadavers, US visualization of the distended calyces during puncture was good. (Fig. 2A+D2) Skin entrance was more difficult and less realistic in TEC, while kidney puncture and dilation were very realistic. (Fig. 2B+C) Ureteral and collecting system anatomy and consistency are similar to real life, although the mucosa appeared paler.(Fig 2.D1) US needle guidance was perceived as excellent. Needle puncture assessment was realistic and useful as training.(Fig 2.D3)Overall quality and satisfaction of TEC in US guided, supine ECIRS is good to excellent and comparable to a real-life procedure. Overall appropriateness of the TEC model was considered excellent for both initial and advanced supine PCNL training.(Fig 2.D4)
Conclusions: We have demonstrated that despite the minor drawbacks of tough skin and non-ideal collecting system dilation during ureteroscopy, the TEC model is considered good to excellent as training model for PCNL, in particular US guided needle puncture of the kidney during supine PCNL.