Practical PCNL: From Access to Exit - A Hands-On Course (2017)
Because of the relative paucity of PCNL cases in training programs which are not high-volume centers, many residents do not gain enough practical experience to feel comfortable with obtaining percutaneous access and performing PCNL. Concerns over morbidity of the operation due to a lack of familiarity and ability to troubleshoot challenges or complications may lead surgeons to avoiding PCNL when it is the ideal surgical approach to a stone. Making the 'rare' case into a 'routine' one by enabling hands-on experience in all phases of the surgery will address the gap in practice, allowing more urologists to offer PCNL to their patients.
Target Audience
- Urologist
Learning Objectives
Upon completion of this course, attendees will be able to:
- Obtain percutaneous access to the kidney using fluoroscopy in combination with ureteroscopic and/or ultrasound guidance.
- Review instrumentation integral to optimizing PCNL success (including tract dilation, graspers, baskets, flexible nephroscopy).
- Perform prone flexible cystoscopy.
- Demonstrate the optimal methods for post-operative sealing or drainage of the percutaneous tract.
- Utilize flexible ureteroscopy and instrumentation in combination with PCNL to enhance renal access and stone treatment success.
- Routinely employ a ureteral access sheath during flexible ureteroscopy.
- Perform and review ultrasound imaging.
- Recognize and manage complications of PCNL.
- Apply knowledge gained in this course to develop a practice in which PCNL becomes an integral surgical procedure in the treatment of stone disease.
Saturday, February 25, 2017
6:00 – 7:00 a.m. Registration & Continental Breakfast
7:00 – 7:05 a.m. Welcome
7:05– 7:15 a.m. Pre-test
7:15 – 7:35 am Pre-procedural Planning and 3D CT Imaging
Zhamshid H. Okhunov, MD
7:35 – 7:50 am Renal Anatomy for Percutaneous Stone Removal
Duane D. Baldwin, MD
7:50 – 8:10 am Patient Positioning: Prone, Supine, and Lateral
Roshan M. Patel, MD
8:10 – 8:30 am Fundamentals of Fluoroscopy and Radiation Safety
Duane D. Baldwin, MD
8:30 – 8:50 am Fluoroscopy Guided Percutaneous Access: “Bull’s Eye” and “Drift Down”
Jaime Landman, MD
8:50 – 9:05 am Break
9:05 – 9:30 am Fundamentals of Renal Ultrasound
Chandana Lall, MD
9:30 – 9:50 am Ultrasound-guided Percutaneous Access
Kari Nelson, MD
9:50 – 10:10 am Endoscopic-guided Percutaneous Access: Prone Cystoscopy/Ureteral Access Sheath
Kamaljot Kaler, MD, FRCSC
10:10 – 10:30 am Dilation of the Nephrostomy Tract: Technique and Avoidance of Complications
Thomas Chi, MD
10:30 – 10:45 am Break
10:45 – 11:05 am Lithotripsy: Pneumatic, Ultrasound and Laser
Jaime Landman, MD
11:05 – 11:25 am Flexible Nephroscopy: Tips and Tricks
Robert Marten Sweet, MD, FACS
11:25 – 11:45 am Ending the Procedure: Tube and Tubeless Techniques
Matthew David Dunn, MD
11:45 am – 12:15 pm Better than Live: Putting it All Together (Video Session)
Ralph V. Clayman, MD
12:15 – 1:00 pm Lunch
Surgical Skills Lab
1:00 – 3:00 pm Group 1: Endoscopic/Fluoroscopic Cadaver PCNL: Start to Finish
1:00 – 3:00 pm Group 2: Surgical Skills Stations
3:00 – 3:30 pm Break
3:30 – 5:30 pm Group 2: Endoscopic/Fluoroscopic Cadaver PCNL: Start to Finish
3:30 – 5:30 pm Group 1: Surgical Skills Stations
Sunday, February 26, 2017
6:30 – 7:30 am Breakfast
7:30 - 8:00 am Challenges of PCNL: Tips and Tricks (Horseshoe Kidney, Calyceal Diverticulum, Pelvic Kidney, Spinal Abnormalities)
Matthew David Dunn, MD
8:00 - 8:30 am PCNL: Complications of PCNL/URS: Prevention, Recognition, and Resolution
Thomas Chi, MD
8:30 - 8:50 am Follow-up: Imaging, Laboratory Studies, Postoperative Visits, Quality of Life Issues and Management of Stent Pain
Robert Marten Sweet, MD, FACS
8:50 - 9:20 am Medical Management of Kidney Stones: Stone Trees
Ralph V. Clayman, MD
9:20 - 9:35 am Break
9:35 - 9:55 am Billing in the Age of ICD-10
Christy Shanley, CPC, CUC
9:55 - 10:10 am Review of AUA Guidelines for PCNL
Ramy F. Youssef-Yaacoub, MD
10:10 – 11:10 am Panel Session: PCNL Cases (Instructive and Problematic)
Moderator: Jaime Landman, MD
Panel: Duane D. Baldwin, MD; Thomas Chi, MD; Matthew David Dunn, MD; Robert Marten Sweet, MD, FACS; Ramy F. Youssef-Yaacoub, MD
11:10 – 11:40 am PCNL Start to Finish: Rapid Fire Review and Questions: What’s the Next Step (Interactive audience response with Poll Everywhere)
Ralph V. Clayman, MD
11:40 am – Noon Post-test/Questions/Adjourn
Name | Company | Role | Financial |
D. Duane Baldwin, MD | Cook Urological, Inc. | Meeting Participant or Lecturer | Yes |
Olympus Corporation | Consultant or Advisor | Yes | |
Bard Medical Divison | Consultant or Advisor | Yes | |
Thomas Chi , MD | Bard | Meeting Participant or Lecturer | Yes |
Boston Scientific Corporation | Consultant or Advisor | Yes | |
Ralph V. Clayman, MD | Applied Urology | Investment Interest | Yes |
Greenwald Inc. | Other | Yes | |
MizuhOSI | Other | Yes | |
Boston Scientific | Other | Yes | |
Cook Urological | Other | Yes | |
Auris Inc. | Consultant or Advisor,Scientific Study or Trial | Yes | |
Spectrum Pharmaceutical | Consultant or Advisor | Yes | |
Matthew D. Dunn, MD | Boston Scientific | Consultant or Advisor,Scientific Study or Trial | Yes |
luminous | Meeting Participant or Lecturer | Yes | |
Kamaljot Kaler,MD | Cook | Meeting Participant or Lecturer | Yes |
Chandana Lall, MD | Nothing to disclose. | ||
Jaime Landman, MD | Cook Urological | Consultant or Advisor,Owner, Product Development | No |
Galil Medical | Consultant or Advisor | Yes | |
CONMED | Consultant or Advisor | Yes | |
Auris | Consultant or Advisor,Investment Interest | Yes | |
Allergan | Scientific Study or Trial | Yes | |
Kari Nelson, MD | Nothing to disclose. | ||
Zhamshid H. Okhunov, MD | Nothing to disclose. | ||
Roshan M. Patel, MD | Nothing to disclose. | ||
Christy Shanley | Nothing to disclose. | ||
Robert M. Sweet, MD | American Urological Association | Consultant or Advisor,Meeting Participant or Lecturer,Scientific Study or Trial | Yes |
Society of Laparoendoscopic Surgeons | Leadership Position,Consultant or Advisor,Meeting Participant or Lecturer,Scientific Study or Trial,Other | No | |
Ramy F. Youssef-Yaacoub,MD | Nothing to disclose. |
Accreditation: The American Urological Association (AUA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation: The American Urological Association designates this live activity for a maximum of 13.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Other Learners: The AUA is not accredited to offer credit to participants who are not MDs or DOs. However, the AUA will issue documentation of participation that states that the activity was certified for AMA PRA Category 1 Credit™.
Evidence Based Content: It is the policy of the AUA to ensure that the content contained in this CME activity is valid, fair, balanced, scientifically rigorous, and free of commercial bias.
AUA Disclosure Policy: All persons in a position to control the content of an educational activity (i.e., activity planners, presenters, authors) are required to disclose to the provider any relevant financial relationships with any commercial interest. The AUA must determine if the individual’s relationships may influence the educational content and resolve any conflicts of interest prior to the commencement of the educational activity. The intent of this disclosure is not to prevent individuals with relevant financial relationships from participating, but rather to provide learners information with which they can make their own judgments.
Resolution of Identified Conflict of Interest: All disclosures will be reviewed by the program/course directors or editors for identification of conflicts of interest. Peer reviewers, working with the program directors and/or editors, will document the mechanism(s) for management and resolution of the conflict of interest and final approval of the activity will be documented prior to implementation. Any of the mechanisms below can/will be used to resolve conflict of interest:
- Peer review for valid, evidence-based content of all materials associated with an educational activity by the course/program director, editor, and/or Education Content Review Committee or its subgroup.
- Limit content to evidence with no recommendations
- Introduction of a debate format with an unbiased moderator (point-counterpoint)
- Inclusion of moderated panel discussion
- Publication of a parallel or rebuttal article for an article that is felt to be biased
- Limit equipment representatives to providing logistics and operation support only in procedural demonstrations
- Divestiture of the relationship by faculty
Off-label or Unapproved Use of Drugs or Devices: It is the policy of the AUA to require the disclosure of all references to off-label or unapproved uses of drugs or devices prior to the presentation of educational content. The audience is advised that this continuing medical education activity may contain reference(s) to off-label or unapproved uses of drugs or devices. Please consult the prescribing information for full disclosure of approved uses.
Available Credit
- 13.00 AMA PRA Category 1 Credit™
- 13.00 Non-Physician Participation