Abstract
ObjectivesTo investigate the learning curve of percutaneous nephrolithotomy under total ultrasound guidance.MethodsOne hundred and twenty consecutive PCNL operations under total ultrasound guidance performed by a novice surgeon in a tertiary referral center were studied. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for the variables such as operation duration, ultrasound screening time, tract dilation time, stone-free rate and complication rate. Comparison was made with the results of a surgeon who had performed more than 1000 PCNLs. Fluoroscopy was not used at all during procedure.ResultsThe mean operation time dropped from 82.5 min for the first 15 patients to a mean of 64.7 min for cases 46 through 60(P = 0.047). The ultrasound screening time was a peak of 6.4 min in the first 15 cases, whereas it dropped to a mean of 3.9 min for cases 46 through 60(P = 0.01). The tract dilation time dropped from 4.9 min for the first 15 patients to a mean of 3.8 min for cases 46 through 60(P = 0.036). The senior surgeon had a mean operating time, screening time and tract dilation time equivalent to those of the novice surgeon after 60 cases. There was no significant difference in stone free rate and complication rate.ConclusionsThe competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications.
Highlights
Since its introduction in 1976, percutaneous nephrolithotomy (PCNL) has been considered the preferred approach to large stones, stones in the lower pole, or stones that are resistant to less invasive technology[1]
There was no significant difference in stone free rate and complication rate
The competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications
Summary
Since its introduction in 1976, percutaneous nephrolithotomy (PCNL) has been considered the preferred approach to large stones, stones in the lower pole, or stones that are resistant to less invasive technology[1]. It has been reported that a novice surgeon can be exposed to radiation doses that are as high as1440 cGy/cm while undertaking their first procedures; the exposure to radiation is not insignificant[3]. Ultrasonography eliminates the hazards associated with exposure to radiation, and it can be used reliably to locate renal stones, especially non-opaque stones that are not visible using fluoroscopy. Neighboring organs such as the bowel, liver, spleen, and lung, can be identified and their injury can be avoided during puncture[5].This technique helps the novice surgeon to develop the percutaneous access method, thereby contributing to low complication rates, especially while learning the technique
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
