A biological model to teach percutaneous nephrolithotomy technique with ultrasound- and fluoroscopy-guided access

Abstract

Purpose: To develop a training model for simulated percutaneous nephrolithotomy (PCNL) under ultrasound and fluoroscopy-guided access.

Materials and methods: The laboratory model for PCNL described by Hammond and associates (J Urol 2004;172:1950-1952) was modified. We used an ex-vivo perfused porcine kidney (freshly removed after commercial slaughtering), a chicken carcass (supermarket), as well as the standard equipment for PCNL. For imaging, ultrasound (7.5 MHz) and a fluoroscopy unit are necessary. Artificial stone material is implanted in the renal pelvis. The ureter is cannulated for retrograde pyelography and the renal artery and vein for continuous perfusion. The perfused kidney surrounded by ultrasound gel is placed in the eviscerated chicken carcass.

Results: The model is low cost and simple to set up, with a preparation time of about 15 minutes. The equipment used in clinical practice can be employed for renal access, tract dilation, nephroscopy, stone disintegration, and stone removal. Imaging is feasible under fluoroscopic and ultrasound guidance.

Conclusions: This biological training model simulates realistically the clinical procedure of PCNL under ultrasound and fluoroscopic guidance. Teaching and skill acquisition are practicable.