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Cao Z, Xiu Y, Yu D, Li X, Yang C, Li Z. Clinical Value of Mixed Reality-Assisted Puncture Navigation for Percutaneous Nephrolithotripsy. Urology 2023; 176:219-225. [PMID: 36921844 DOI: 10.1016/j.urology.2022.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To evaluate the clinical value of mixed reality-assisted puncture navigation (MRAPN) in percutaneous nephrolithotripsy (PCNL). METHODS Two hundred patients undergoing PCN were enrolled, all of whom had kidney stones to be subjected to lithotripsy by PCNL and grouped according to surgical procedure into the MRAPN (n = 100) and non-mixed reality-assisted puncture (non-MRAPN) (n = 100) groups. CT data in DICOM format for all patients in the MRAPN group were imported into 3D reconstruction and mixed reality (MR) post-processing workstations, and holographic 3D visualization modelling. Comparing parameters such as the operative time (OT), puncture time (PT), number of attempts, and estimated blood loss (EBL), a Likert scale was used to assess the clinical value of MRAPN. The Cohen κ coefficient (k) was employed to evaluate consistency among assessors; safety was assessed. RESULTS There were no significant differences in patient demographic indicators or preoperative general information between the MRAPN and non-MRAPN groups (P > .05). The clinical value of MRAPN was higher for subjective scores regarding surgical planning, intraoperative navigation, didactic guidance and physician-patient communication (all P < .001). The PT was significantly shorter in the MRAPN group (P < .001), with a shorter overall OT and lower EBL (P < .001). There were no significant differences in the overall comparison, length of hospital stay, or preoperative or postoperative creatinine (all P > .05). CONCLUSION MRAPN can safely and effectively improve the success of PCN, reduce complications, and decrease the PT, OT, and EBL.
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Affiliation(s)
- Zhiqiang Cao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Department of Burn and Plastic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yiping Xiu
- Department of Burn and Plastic Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Dongyang Yu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xinyang Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Caleb Yang
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA
| | - Zhenhua Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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2
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Aydın A, Baig U, Al-Jabir A, Sarıca K, Dasgupta P, Ahmed K. Simulation-Based Training Models for Urolithiasis: A Systematic Review. J Endourol 2021; 35:1098-1117. [PMID: 33198492 DOI: 10.1089/end.2020.0408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives: Urolithiasis is one of the most common presentations in urological practice and it is becoming increasingly important to provide structured, simulation-based training using validated training models. This systematic review aims to identify current simulation-based training models and to evaluate their validity and effectiveness. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was performed on the Medline and EMBASE databases for English language articles published between 2000 and 2018 describing and/or assessing validity of simulation models for urolithiasis procedures. Studies were qualitatively assessed for validity using the Messick validity framework and models were assigned levels of recommendation using the McGaghie model of translational outcomes. Results: A total of 98 studies were included in this study assessing 51 models, with 28 studies concerning models for urethrocystoscopy, 46 studies for ureterorenoscopy, and 39 studies for percutaneous access and/or nephrolithotomy. Only four models demonstrated a level of recommendation of 4. The most validated models were the URO/PERC-Mentor (Simbionix, Lod, Israel) with multiple studies for each across various procedural skills. Conclusion: There is a wide spectrum of simulation-based models currently available for urolithiasis procedures, mostly with limited validity evidence from small studies. Further research is required with higher levels of evidence including randomized controlled trials. In addition, long-term transfer of skills to the operating room should be assessed to establish whether there is genuine skill development and retention using simulation models and whether this helps to reduce surgical complications.
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Affiliation(s)
- Abdullatif Aydın
- MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Umair Baig
- MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Ahmed Al-Jabir
- MRC Centre for Transplantation, King's College London, London, United Kingdom
| | - Kemal Sarıca
- Department of Urology, Biruni University Hospital, Istanbul, Turkey
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, United Kingdom.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, United Kingdom.,Department of Urology, King's College Hospital NHS Foundation Trust, London, United Kingdom
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3
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Rassweiler-Seyfried MC, Lima E, Ritter M, Klein JT, Michel MS. [Navigation systems for the percutaneous access to the kidney]. Urologe A 2020; 59:1017-1025. [PMID: 32533201 DOI: 10.1007/s00120-020-01250-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Percutaneous access to the renal pelvis still remains the most difficult step before nephrolitholapaxy (PCNL). New imaging techniques, such as 3D imaging and various navigation instruments such as electromagnetic, sonographic, CT-controlled and marker-based/iPAD try to simplify this step and reduce complications. OBJECTIVES In this review, various new techniques for puncturing the renal collecting system are presented and their advantages and disadvantages are evaluated. MATERIALS AND METHODS A systematic literature search was carried out in MEDLINE, whereby only puncture techniques that have already been evaluated in clinical studies were included. RESULTS Five different navigation methods for puncturing the renal pelvis before PCNL were found. CONCLUSION Intraoperative navigation can be useful when puncturing the collecting system. The combination of ultrasound and fluoroscopy currently remains the gold standard. However, there is still a need for further, primarily clinical, prospective studies to determine which new imaging technology and navigation systems will prevail and thus facilitate the access route to the kidney, especially in the case of special anatomical conditions.
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Affiliation(s)
- M-C Rassweiler-Seyfried
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland.
| | - E Lima
- Department of Urology - Hospital of Braga, University of Minho, Campus de Gualtar, 4709-057, Braga, Portugal
| | - M Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - M-S Michel
- Klinik für Urologie und Urochirurgie, Universitätsmedzin Mannheim, Theodor-Kutzer-Ufter 1-3, 68161, Mannheim, Deutschland
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Rowley KJ, Liss MA. Systematic Review of Current Ultrasound Use in Education and Simulation in the Field of Urology. Curr Urol Rep 2020; 21:23. [PMID: 32378073 DOI: 10.1007/s11934-020-00976-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF THE REVIEW We investigate articles in the literature published in the last 5 years (2014-2019) regarding ultrasound education in the specialty of urology. RECENT FINDINGS Ultrasound has been touted as the modern day stethoscope. Medical educational governing bodies have encouraged the incorporation of ultrasound in medical school education. However, in this review, we find that there are gaps in educational opportunities and standardization in residency and continuing education for urology practitioners. We have identified several new tools for procedure-specific training published in the last 5 years including MRI fusion prostate biopsy and percutaneous nephrolithotomy. New technology is being fused with traditional ultrasound training to provide procedure-specific ultrasound knowledge. There is a need to incorporate new technology and standards into resident and continuing medical education.
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Affiliation(s)
- Keri J Rowley
- Department of Urology, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Michael A Liss
- Department of Urology, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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Kozan AA, Chan LH, Biyani CS. Current Status of Simulation Training in Urology: A Non-Systematic Review. Res Rep Urol 2020; 12:111-128. [PMID: 32232016 PMCID: PMC7085342 DOI: 10.2147/rru.s237808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Simulation has emerged as an effective solution to increasing modern constraints in surgical training. It is recognized that a larger proportion of surgical complications occur during the surgeon's initial learning curve. The simulation takes the learning curve out of the operating theatre and facilitates training in a safe and pressure-free environment whilst focusing on patient safety. The cost of simulation is not insignificant and requires commitment in funding, human resources and logistics. It is therefore important for trainers to have evidence when selecting various simulators or devices. Our non-systematic review aims to provide a comprehensive up-to-date picture on urology simulators and the evidence for their validity. It also discusses emerging technologies and future directions. Urologists should embed evidence-based simulation in training programs to shorten learning curves while maintaining patient safety and work should be directed toward a validated and agreed curriculum.
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Affiliation(s)
- Andrei Adrian Kozan
- Department of Urology, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Luke Huiming Chan
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Chandra Shekhar Biyani
- Department of Urology, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
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Golan R, Shah O. Performance Optimization Strategies for Complex Endourologic Procedures. Urology 2020; 139:44-49. [PMID: 32045590 DOI: 10.1016/j.urology.2020.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To identify and address factors that may impact a surgeon's performance during endourologic procedures. METHODS A literature review was performed for articles focusing on surgical ergonomics, education, sports and performance psychology. RESULTS As urologists and trainees have become more comfortable approaching complex pathology endoscopically, there remains an opportunity to refine surgeon-related factors and optimize extrinsic factors to maximize efficiency and provide patients with the highest quality outcomes and safety. CONCLUSION Medical centers and training programs should strive to include formal lessons on stress-coping mechanisms, communication, and dedicated ergonomic training, as these all play a role in physician well-being and may lead to improved clinical outcomes.
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Affiliation(s)
- Ron Golan
- Department of Urology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY.
| | - Ojas Shah
- Department of Urology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY.
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Extracorporeal shock-wave lithotripsy: is it still valid in the era of robotic endourology? Can it be more efficient? Curr Opin Urol 2020; 30:120-129. [PMID: 31990816 DOI: 10.1097/mou.0000000000000732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The aim of the article is to evaluate the actual role of extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis based on the new developments of flexible ureterorenoscopy (FURS) and percutaneous nephrolithotomy (PCNL). RECENT FINDINGS In Western Europe, there is a significant change of techniques used for treatment of renal stones with an increase of FURS and a decrease of ESWL. The reasons for this include the change of indications, technical improvement of the endourologic armamentarium, including robotic assistance. Mostly relevant is the introduction of digital reusable and single-use flexible ureterorenoscopes, whereas micro-PCNL has been abandoned. Some companies have stopped production of lithotripters and novel ideas to improve the efficacy of shock waves have not been implemented in the actual systems. Promising shock-wave technologies include the use of burst-shock-wave lithotripsy (SWL) or high-frequent ESWL. The main advantage would be the very fast pulverization of the stone as shown in in-vitro models. SUMMARY The role of ESWL in the management of urolithiasis is decreasing, whereas FURS is constantly progressing. Quality and safety of intracorporeal shock-wave lithotripsy using holmium:YAG-laser under endoscopic control clearly outweighs the advantages of noninvasive ESWL. To regain ground, new technologies like burst-SWL or high-frequent ESWL have to be implemented in new systems.
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Veys R, Verpoort P, Van Haute C, Wang ZT, Chi T, Tailly T. Thiel‐embalmed cadavers as a novel training model for ultrasound‐guided supine endoscopic combined intrarenal surgery. BJU Int 2019; 125:579-585. [DOI: 10.1111/bju.14954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ralf Veys
- Department of Urology University Hospital Ghent Ghent Belgium
| | - Pieter Verpoort
- Department of Urology University Hospital Ghent Ghent Belgium
| | - Carl Van Haute
- Department of Urology University Hospital Brugmann Brussels Belgium
| | - Zhan Tao Wang
- Department of Surgery Division of Urology Western University London Ontario Canada
| | - Thomas Chi
- Department of Urology University of California‐San Francisco San Francisco California USA
| | - Thomas Tailly
- Department of Urology University Hospital Ghent Ghent Belgium
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Rassweiler-Seyfried MC, Rassweiler JJ, Weiss C, Müller M, Meinzer HP, Maier-Hein L, Klein JT. iPad-assisted percutaneous nephrolithotomy (PCNL): a matched pair analysis compared to standard PCNL. World J Urol 2019; 38:447-453. [PMID: 31073641 DOI: 10.1007/s00345-019-02801-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/04/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare iPad-assisted (Apple Inc., Cupertino, USA) percutaneous access to the kidney to the standard puncturing technique for percutaneous nephrolithotomy (PCNL). METHODS For the iPad-assisted PCNL, a computed tomography is performed prior to surgery, using fiducial radiopaque markers. The important anatomical structures (i.e. kidney, stones) are segmented using specific software enabling the superimposition of images semi-transparently on the iPad by marker-based navigation. Twenty-two patients underwent an iPad-assisted percutaneous puncture of the kidney for PCNL. Twenty-two patients of the clinical database from the Urological Department SLK Hospital Heilbronn, who underwent the standard puncturing technique, were matched to these patients. Matching criteria were age, gender, stone volume, body mass index, stone site and the absence of anatomical variation. Puncture time, radiation exposure and number of attempts for a successful puncture were evaluated. All procedures were performed by two experienced urologists. The standard puncturing method consisted of a combination of ultrasound and fluoroscopy guidance. Chi-square and t test were used to ensure that there was no difference in the matching criteria between the groups. To compare the two methods, U test, Kruskal-Wallis and Chi-square test were used. RESULTS Examination of radiation exposure showed a significant difference between the two groups in favour of the standard puncturing method (p < 0.01) and puncture time (p = 0.01). However, there was no significant difference in puncturing attempts (p = 0.45). CONCLUSION The iPad-assisted navigation, with the objective being to puncture the renal collecting system, represents a new technique (IDEAL criteria 2b), which proved to be applicable in clinical practice, but still has potential for technical improvement.
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Affiliation(s)
- Marie-Claire Rassweiler-Seyfried
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - J J Rassweiler
- Department of Urology, SLK Hospital Heilbronn, University of Heidelberg, Heilbronn, Germany
| | - C Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Müller
- Department of Medical and Biological Informatics, German Cancer Research Centre (DKFZ), Heilbronn, Germany
| | - H P Meinzer
- Department of Medical and Biological Informatics, German Cancer Research Centre (DKFZ), Heilbronn, Germany
| | - L Maier-Hein
- Department of Medical and Biological Informatics, German Cancer Research Centre (DKFZ), Heilbronn, Germany
| | - J T Klein
- Department of Urology, Ulm University Medical Centre, Ulm, Germany
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Johnson BA, Timberlake M, Steinberg RL, Kosemund M, Mueller B, Gahan JC. Design and Validation of a Low-Cost, High-Fidelity Model for Urethrovesical Anastomosis in Radical Prostatectomy. J Endourol 2019; 33:331-336. [PMID: 30734578 DOI: 10.1089/end.2018.0871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We sought to develop and validate a low-cost, high-fidelity robotic surgical model for the urethrovesical anastomosis component of the robot-assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS A novel simulation model was constructed using a 3D-printed model of the male bony pelvis from CT scan data and silicone molds to recreate the soft tissue aspects. Using a da Vinci Si surgical robot, urology faculty and trainees performed simulated urethrovesical anastomosis. Each participant was given 12 minutes to complete the simulation. A survey established face validity, content validity, and acceptability. Simulation runs were evaluated by three blinded reviewers. The anastomosis was graded by two reviewers for suture placement accuracy and anastomosis quality. These factors were compared with robotic experience to establish construct validity. RESULTS Twenty participants took part in the initial validation of this model. Groups were defined as experts (surgical faculty), intermediate (fellows and chief residents), and novices (junior residents). Likert scores (1-5 scale, top score 5) examining face validity, content validity, and acceptability were 3.49 ± 0.43, 4.15 ± 0.23, and 4.02 ± 0.19, respectively. Construct validity was excellent based on the model's ability to stratify groups. All evaluated metrics were statistically different between the three levels of training. Total material cost was $2.50 per model. CONCLUSIONS We developed a novel low-cost robotic simulation of the urethrovesical anastomosis for robot-assisted radical prostatectomy. The model discerns robotic skill level across all levels of training and was found favorable by participants showing excellent face, content, and construct validities.
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Affiliation(s)
- Brett A Johnson
- 1 Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Matthew Timberlake
- 1 Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Ryan L Steinberg
- 1 Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Matthew Kosemund
- 2 Center for Simulation, The University of Texas Southwestern, Dallas, TX
| | - Bradly Mueller
- 2 Center for Simulation, The University of Texas Southwestern, Dallas, TX
| | - Jeffrey C Gahan
- 1 Department of Urology, University of Texas Southwestern, Dallas, Texas
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McDougall EM. Editorial Comment on: Validation of a Novel Cost Effective Easy to Produce and Durable In Vitro Model for Kidney-Puncture and Percutaneous Nephrolitholapaxy-Simulation by Klein et al. J Endourol 2018; 32:877. [PMID: 29905086 DOI: 10.1089/end.2018.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elspeth M McDougall
- Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
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