Presentation Authors: Ahmed Ibrahim*, Montreal, Canada, Yasser Noureldin, Benha, Egypt, Sero Andonian, Montreal, Canada
Introduction: Obtaining the percutaneous renal access is considered the critical step in performing percutaneous nephrolithotomy (PCNL). The aim was to assess the transfer of percutaneous access skills gained from training on the PERC MentorTM simulator to the operating room.
Methods: After obtaining ethics approval, urology Post-Graduate Trainees (PGTs) from Post-Graduate Years (PGY) 4 and 5 were recruited. Participants received educational demonstration on how to perform the PCA using bull&[prime]s eye technique prior to being asked to perform task 5 on the PERC Mentor simulator (Simbionix, Cleveland, Ohio, USA), where they had to correctly puncture the middle calyx over a stone in a left kidney model. All participants were assessed objectively by the PERC Mentor simulator and subjectively by the validated Percutaneous Nephrolithotomy-Global Rating Scale (PCNL-GRS) tool. The learning curve was assessed in terms of reaching competency in performing the PCA with plateauing in PCNL-GRS score, operative and fluoroscopy times, and absence of complications. To assess the transfer of PCA skills from the PERC Mentor simulator to the operating room (OR), all participants were asked to perform PCA inside the OR and were assessed using the same PCNL-GRS score. The relationship between the PCNL-GRS score, operative time, fluoroscopy time, and complications on the simulator and inside the OR was addressed.
Results: Eight urology PGTs (5 PGY-4 and 3 PGY-5), with median age of 30 (27.8-32.3) years and without prior PCNL experience, participated in this study. Participants performed a total of 72 PCA procedures, with mean operative time of 155.8Â±14 seconds, and mean fluoroscopy time of 89.9Â±9 seconds, mean number of attempts to puncture the PCS of 1.8Â±0.3, mean pelvi-calyceal system (PCS) perforation of 0.88Â±0.2, mean vascular injury of 0.5Â±0.08, and PCNL-GRS score of 21.8Â±0.6. Competency in task 5 on the PERC Mentor simulator was achieved after five trials in terms of the PCNL-GRS score, 14 trials in terms of the operative and fluoroscopy times and PCS perforations, and 9 trials in terms of the vascular injury. Furthermore, participants performed 20 PCA procedures with mean time to achieve successful puncture of 120Â±15 seconds, mean fluoroscopy time of 27.2Â±4.7 seconds, mean attempts to puncture the PCS of 1.5Â±0.2, mean PCNL-GRS score of 20.3Â±0.9. However, one case (5%) of colon perforation was encountered and 2 cases (10%) was associated with failed puncture.
Conclusions: While training on PERC MentorTM simulator is associated with improving the learning curve of the trainees in terms of operative and fluoroscopy times, the optimal PCNL simulator is still required in order to overcome certain PCNL challenges and reduce intraoperative complications.