Implementation of a focused curriculum on flexible ureteroscopic surgery: a multi-institutional collaborative effort

Abstract

Flexible ureteroscopy with Holmium:YAG laser lithotripsy (Flex URS/Laser) has a known learning curve; although this laser is the safest flexible intracorporeal lithotrite, complications have been reported to occur with greater frequency early in its adoption. Herein, we review the implementation of a didactic and practical curriculum to introduce the Holmium:YAG laser for flexible URS. Following the initial tutorial period, we assessed procedure outcomes and complications. In September 2009 a 15 Watt Holmium:YAG laser was introduced to the operating suite at Hospital Punta Pacifica, a newly developed hospital affiliated with Johns Hopkins Medicine International. We developed a curriculum that included both classroom-based lectures and live surgical experience. The lectures were designed to review the laser's properties as well as its surgical applications; live surgeries were then performed, initially as demonstrations and then as mentored procedures. The medical records of all patients undergoing Flex URS/Laser in the 12 months following this program were reviewed, to assess for outcomes and complications. A total of 32 Flex URS/Laser procedures were performed. Mean age was 44.1 years, and there were 19 males, 13 females. Five stones were located in the ureter, with the remainder in the kidney. All stones were accessed and fragmented with the laser, and no peri-operative or post-operative complications were encountered. A focused didactic and practical curriculum can simplify the introduction of Flex URS/Laser, and permit the rapid achievement of acceptable results. An emphasis on limiting active fragment extraction will reduce the likelihood of ureteral injuries, a potentially devastating complication which may be more likely to occur early in the adoption of Flex URS/Laser.