A Cheaper Simulator for Learning Percutaneous Renal Access: A Latex Glove Model

Abstract

Introduction: The most difficult step of percutaneous renal surgery is to obtain an appropriate access to the renal cavities, which reduces the risk of vascular injury and leads to a better stone-free rate.1–3 Model-based training that provides experience in percutaneous renal access may reduce the learning curve associated with the procedure and increase the safety profile for beginners as they gain experience on patients.2,3 Thus, many biological models with porcine kidney and virtual reality simulator have been developed, to facilitate the learning and training of percutaneous renal surgery.3,4–7 We present a video of a cheaper and easily available model using a latex glove for percutaneous calyx puncture. Materials and Methods: Two or three foam layers are used to simulate the abdominal wall layers. A ureteral catheter is inserted in a latex glove, which is closed using a few ligations. The glove is filled with saline solution and contrast media. It is placed on the distal half of the foams with the fingers looking toward the middle. The fingers are fixed to the foam using medical tapes. The foams are folded to cover the glove. The puncture, guidewire insertion, and small dilation are performed under fluoroscopic guidance, with the X-ray beam perpendicular to the tract. Thus, the operator's hands are outside the fluoroscopic field, similar to the technique we use in percutaneous renal access.8 Urologist and residents were taught needle access and the beginning of tract dilation. Results: The glove model is simple and quick to set up, with a preparation time of a few minutes. It is economical, by using widely available material. It can be performed in the operating room; since it is a nonbiological model, there is no risk of biologic contamination nor any hygiene or sterilization issue. Percutaneous puncture and limited dilation were possible in all the fingers and with the same techniques used in our real percutaneous access.8,9 The needle mobilization and puncture of the glove's fingertip are similar to the feeling of the calyx puncture. Beside a good fixation to the foam, the fingers have to be tightly filled to be firm to the needle puncture. Otherwise, if the finger is flaccid, the needle will push the fingertip without puncturing it. Moreover, dilation and Amplatz sheath insertion are difficult or impossible; the finger is pushed by the dilator. It is a nonbiological model, so there is a limitation in terms of tissue feeling and for anatomic relations. In addition, ultrasound-imaging guidance cannot be used. Evaluations submitted by training session participants revealed a high degree of satisfaction with model effectiveness in the application of percutaneous calyx puncture. Conclusions: This glove model seems to be an effective means of skills acquisition for percutaneous calyx puncture. Moreover, it is cheap, simple, and quick to set up, with no risks of biologic contamination. However, further technical experience and comparative studies with biologic and virtual reality simulators are necessary to evaluate this technique. No competing financial interests exist. Run time of video: 5 mins 20 secs