Introduction & Objectives
Percutaneous renal surgery is one of the advanced techniques in current endourology. Percutaneous renal access is associated with a steep learning curve, when done well, the remainder PCNL can be performed in a straightforward manner. To perform the calyx puncture competently a urologist needs to have a good knowledge of many aspects: anatomical and procedural as well as develop basic skills.
For this reason the objective of this study is to evaluate the efficacy of the porcine model for the apprenticeship of the percutaneous approach of the upper urinary tract under fluoroscopic and ultrasound guidance.
Material & Methods
The animal model chosen was the female swine model (35-40 kg), with multicalicial kidney. To facilitate the percutaneous approach, a laparoscopic unilateral ureteral stricture model (with or without stones) was performed two weeks before the practice, which gradually causes a pyelocalyceal dilatation. The approach used for the calicial puncture was the supine position. The steps were the same for both the ultrasound and the fluoroscopic guidance: calicial puncture, tract dilatation, nephroscopy and nephrostomy tube placement. Trainees worked in pairs under supervision of a trained mentor. The evaluation of the results was done through an anonymous survey to 174 trainees who participated in this basic training (2007-2017). The survey described the skills acquired and the suitability of the animal model.
79.3% of the trainees confirmed that they improved a lot with this training model, 13.2% improved moderately and 7.5% considered the gain small. The trainees graded this practices with a 9.3 (range 0-10). 77.8% believed that after this training activity, they would be able to carry out these techniques at their hospitals. 99% of the trainees would recommend this activity to their colleagues. The main drawbacks of the pig model are the excessive mobility of the kidneys and the different anatomical references.
The use of the porcine animal model with upper urinary tract dilatation is, according to trainees, effective in the initial phases of the learning curve of percutaneous endourological techniques. It allows the acquisition of basic skills to safely face these techniques. Therefore, the use of this animal model is expected to reduce the learning curve and the iatrogenic risks in the first steps of training in the anterograde approach of the urinary tract.