Simplified biplanar (0-90 degrees) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve
Por:
Manzo, BO, Torres, JE, Cabrera, JD, Lozada, E, Emiliani, E, Sepulveda, F, Morales, C, Morales, I, Sanchez, HM
Publicada:
1 sep 2021
Ahead of Print:
1 mar 2021
Resumen:
Purpose To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90o) puncture technique for percutaneous nephrolithotomy. Methods We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90o) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon. Results Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures. Conclusion This study suggests that with the simplified biplanar (0-90o) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.
Filiaciones:
Manzo, BO:
Hosp Reg Alta Especialidad BajioLeon, Endourol Deparment, Blvd Campestre 306 Int 410, Leon 37160, Gto, Mexico
Torres, JE:
Hosp Reg Alta Especialidad BajioLeon, Endourol Deparment, Blvd Campestre 306 Int 410, Leon 37160, Gto, Mexico
Cabrera, JD:
Hosp Reg Alta Especialidad BajioLeon, Endourol Deparment, Blvd Campestre 306 Int 410, Leon 37160, Gto, Mexico
Lozada, E:
HRAEB, Dept Clin Res, Leon, Gto, Mexico
Emiliani, E:
Univ Autonoma Barcelona, Urol Dept, Fdn Puigvert, Barcelona, Spain
Sepulveda, F:
Univ Fed Bahia, Salvador, BA, Brazil
Hosp Mulher Bahia, Salvador, BA, Brazil
Morales, C:
Hosp Parroquial, Urol Dept, San Bernardo, Chile
Univ Los Andes, Santiago, Chile
Morales, I:
Hosp Parroquial, Urol Dept, San Bernardo, Chile
Univ Los Andes, Santiago, Chile
Sanchez, HM:
Hosp Reg Alta Especialidad BajioLeon, Endourol Deparment, Blvd Campestre 306 Int 410, Leon 37160, Gto, Mexico
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