V4-12: Simulation model for ultrasound and fluoroscopy guided percutaneous renal access: step by step tutorial
Percutaneous renal access has been a leading toping in urology for years, given the widespread use of nephrostomy and percutaneous nephrolitotomy (PCNL). Systematic training routine is known to be helpful in laparoscopic and robotic surgery in order to shorten the learning curve. Nevertheless, there is a shortage of training models regarding percutaneous renal access.
We present materials and methods to build a percutaneous renal access model. We propose a homemade devise that allows training using simulated fluoroscopy guided puncture, contributing to shorten learning curve and reduce radiation during this period. Using jelly, our model permits practising the ultrasound guided puncture, both combined with simulated fluoroscopy or independently. In order to make our simulator, we use materials available in any home improvement store.
The materials required to make our model cost less than 130 euros. About 3 hours are required to set up the simulator. We have built a structure that allows rotation and permits fluoroscopy guided puncture at 0 and 30 degrees angle, as the standard technique to identify the position of the needle in the upper-lower and anterior-posterior axis. Furthermore, our simulator permits using simultaneously ultrasound guidance. We have improved imaging using a pinhole system and reflected light in order to avoid magnifying of movements of the needle. With our proposal, we can restore and re-use the jelly puncture model, thereby clearing any puncture tracks.
There is a scarcity of training models covering renal kidney access, one of the main topics in urological surgical access. The lack of simulation sessions results in longer learning curve and additional exposure to ionizing radiation. We propose a complete, versatile and effective model to train both the fluoroscopy and the ultrasound guided renal access.