A NEW APPROACH TO UROLOGY TRAINING:: A LABORATORY MODEL FOR PERCUTANEOUS NEPHROLITHOTOMY

Abstract

The efficacy of traditional operating room based training of urology residents is being reevaluated. The development of hands-on laboratory practicums to facilitate the acquisition of skills by surgical residents lessens learning curves and hastens familiarity with tissue and instrument handling. We describe an innovative model for simulated percutaneous renal access and nephrolithotomy. Porcine kidneys pre-implanted with artificial stone material were placed within intact chicken carcasses as a model for percutaneous nephrolithotomy. Urology residents were taught needle access, tract dilation and renal access sheath insertion using fluoroscopy. Training in percutaneous nephrolithotomy with the nephroscope, graspers and stone fragmentation methods followed. This simple, cost-effective model closely simulates percutaneous nephrolithotomy. Anonymous evaluations submitted by training session participants revealed a high degree of satisfaction with model effectiveness in the application of percutaneous renal access and nephrolithotomy techniques. Our percutaneous nephrolithotomy laboratory model is an effective means of skills acquisition for a complex endourological procedure. Patient care can safely be of secondary importance with respect to trainee experience in a low stress environment that provides an opportunity for supervised, repetitive performance of essential technical skills. We describe an effective percutaneous renal access and nephrolithotomy surgical training model of original design.