Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep;39(9):3657-3663.
doi: 10.1007/s00345-021-03669-7. Epub 2021 Mar 23.

Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve

B O Manzo  1 , J E Torres  2 , J D Cabrera  2 , E Lozada  3 , E Emiliani  4 , F Sepulveda  5 , C Morales  6 , I Morales  6 , H M Sanchez  2
Affiliations

Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve

B O Manzo et al. World J Urol. 2021 Sep.

Abstract

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.

Keywords: Fluoroscopy; Learning curve; Percutaneous; Puncture; Radiation; Renal stones.

PubMed Disclaimer

References

    1. Türk C, Petřík A, Sarica K et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482. https://doi.org/10.1016/j.eururo.2015.07.041 - DOI - PubMed
    1. Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline part II. J Urol 196(4):1161–1169. https://doi.org/10.1016/j.juro.2016.05.091 - DOI - PubMed
    1. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M et al (2007) 2007 guideline for the management of ureteral calculi. J Urol 178:2418–2434. https://doi.org/10.1016/j.juro.2007.09.107 - DOI - PubMed
    1. Wen CC, Nakada SY (2007) Treatment selection and outcomes: renal calculi. Urol Clin North Am 34:409–419. https://doi.org/10.1016/j.ucl.2007.04.005 - DOI - PubMed
    1. Manzo BO, Gómez F, Figueroa A, Sanchez HM, Leal M, Emiliani E et al (2020) A new simplified biplanar (0–90°) fluoroscopic puncture technique for percutaneous nephrolithotomy. Reducing fluoroscopy without ultrasound initial experience and outcomes. Urology 140:165–170. https://doi.org/10.1016/j.urology.2020.03.002 - DOI - PubMed

LinkOut - more resources