V6-09: Training in a novel fluoroscopy simulator (iPerc) reduces emulated radiation time associated to puncture and improves kidney access time in percutaneous nephrolithotomy simulation among urologists with scarce surgical experience
Percutaneous nephrolithotomy (PCNL) is a surgical procedure for kidney stone extraction requiring the development of complex skills. Most of the times it is fluoroscopically guided, thus exposing the surgical team to important doses of radiation. Available PCNL training models require animals and fluoroscopy, therefore being costly and hence unsafe. The iPERC is an ex-vivo device for training in PCNL without fluoroscopy usage. Our objective was to evaluate the efficacy of this model in improving emulated radiation time (ERT) and kidney access time (KAT) in emulated PCNL among scarce experienced urological surgeons and trainees.
We present a prospective study assessing the iPerc performance of 30 urologists with an experience of less than 5 in vivo PCNL procedures (14 residents and 16 attendings in practice). Participants were scored before and after 20 attempts of puncture in our percutaneous access model. The evaluated parameters included KAT, ERT, number of angle-of-vision shifts and number of needle adjustments at 0 and 30 degrees.
By the end of the training, the time required to complete the evaluated tasks decreased significantly: KAT (figure 1) improved from a median of 148 to 77 seconds (p=0.000) and the ERT (figure 2) improved from a median of 101.5 to 45.5 seconds (p=0.000), the overall results are displayed on table 1.
Training in the iPerc model simulates the challenges a surgeon faces during the performance of PCNL procedures, improving ERT and KAT among users. This is a safe and effective training device that neither requires the use of laboratory animals nor radiation exposure.