Comparative evaluation of simulators for practising fluoroscopy-guided renal pelvic puncture

Introduction. The skill of puncture of the kidney pelvicalyceal system is one of the basic urological skills, as it is used for various surgical interventions. There are different training models, from laboratory animals to virtual reality simulators.

Objective. To evaluate a non-biological model of the pelvicalyceal system puncture simulator UroATOM (“Alfa-Rhythm”, Russian Federation) and to compare it with a virtual reality simulator PERC Mentor^TM (“Simbionix”, Beit Golan, Israel).

Materials & methods. The results of fluoroscopic guided puncture training were analyzed among 50 physicians. The specialists were divided into two equal groups by experience: group 1 — beginners, group 2 — experienced urologists. In phase 1, both simulators were evaluated by the physicians using Likert questionnaires. In phase 2, the puncture results in beginners were evaluated before and after the UroATOM simulator practise.

Results. Comparing the indices of both simulators showed that UroATOM was rated as more convenient to use (p = 0.0001) and cheaper (p < 0.0001). The analysis of the puncture performance by "beginners" before and after UroATOM training revealed a statistically significant improvement in the performance. The puncture time index improved by 79 seconds. The index of fluoroscopy duration decreased by 40.9 seconds. The number of puncture attempts decreased by 1.4 times. The amount of contrast decreased by 5.4 ml.

Conclusions. The UroATOM simulator is effective for training young specialists in fluoroscopy-guided renal cavity puncture.

1. Alken P. Percutaneous nephrolithotomy - the puncture. BJU Int. 2022;129(1):17-24. DOI: 10.1111/bju.15564

2. Gadzhiev N.K., Obidnyak V.M., Gorelov D.S., Malkhasyan V.A., Akopyan G.N., Mazurenko D.A., Kharchilava R.R., Petrov S.B., Martov A.G. Complications after PCNL: diagnosis and management. Urologiia. 2020;(5):139–149. (In Russian) DOI: 10.18565/urology.2020.5.139-148

3. Zeng G., Zhong W., Mazzon G., Choong S., Pearle M., Agrawal M., Scoffone C.M., Fiori C., Gökce M.I., Lam W., Petkova K., Sabuncu K., Gadzhiev N.K., Pietropaolo A., Emiliani E., Sarica K. International alliance of Urolithiasis (IAU) guideline on percutaneous nephrolithotomy. Urology Herald. 2022;10(4):179-200. (In Russian). DOI: 10.21886/2308-6424-2022-10-4-179-200

4. Sampaio FJ. Renal anatomy. Endourologic considerations. Urol Clin North Am. 2000;27(4):585-607, vii. DOI: 10.1016/s0094-0143(05)70109-9

5. Noureldin YA, Andonian S. Simulation for Percutaneous Renal Access: Where Are We? J Endourol. 2017;31(S1):S10-S19. DOI: 10.1089/end.2016.0587

6. Guglielmetti GB, Danilovic A, Torricelli FC, Coelho RF, Mazzucchi E, Srougi M. Predicting calyceal access for percutaneous nephrolithotomy with computed tomography multiplanar reconstruction. Clinics (Sao Paulo). 2013;68(6):892-5. DOI: 10.6061/clinics/2013(06)27

7. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10(3):257-9. DOI: 10.1080/21681805.1976.11882084

8. Pietropaolo A, Proietti S, Geraghty R, Skolarikos A, Papatsoris A, Liatsikos E, Somani BK. Trends of 'urolithiasis: interventions, simulation, and laser technology' over the last 16 years (2000-2015) as published in the literature (PubMed): a systematic review from European section of Uro-technology (ESUT). World J Urol. 2017;35(11):1651-1658. DOI: 10.1007/s00345-017-2055-z

9. EAU Guidelines. Edn. presented at the EAU Annual Congress Barcelona 2019. ISBN 978-94-92671-04-2.

10. Guliev B.G., Komyakov B.K., Talyshinskiy A.E., Stetsik E.O., Verdiev N.D. Comparative analysis of the results of standard and minipercutaneous nephrolithotripsy for staghorn stones. Urology Herald. 2022;10(2):32-42. (In Russian). DOI: 10.21886/2308-6424-2022-10-2-32-42

11. Sadiq AS, Atallah W, Khusid J, Gupta M. The Surgical Technique of Mini Percutaneous Nephrolithotomy. J Endourol. 2021;35(S2):S68-S74. DOI: 10.1089/end.2020.1080

12. Popov S.V., Orlov I.N., Sytnik D.A., Radzhabov R.M. Retrograde intrarenal surgery for kidney stones larger than two centimetres. Urology Herald. 2022;10(3):98-105. (In Russian). DOI: 10.21886/2308-6424-2022-10-3-98-105

13. Negrete-Pulido O, Molina-Torres M, Castaño-Tostado E, Loske AM, Gutiérrez-Aceves J. Percutaneous renal access: the learning curve of a simplified approach. J Endourol. 2010;24(3):457-60. DOI: 10.1089/end.2009.0210

14. Saluk J, Ebel J, Rose J, Posid T, Sourial M, Knudsen B. Fellowship training in endourology: Impact on percutaneous nephrolithotomy access patterns. Can Urol Assoc J. 2022;16(2):E76-E81. DOI: 10.5489/cuaj.7339

15. Bridges M, Diamond DL. The financial impact of teaching surgical residents in the operating room. Am J Surg. 1999;177(1):28-32. DOI: 10.1016/s0002-9610(98)00289-x

16. Reznick RK, MacRae H. Teaching surgical skills--changes in the wind. N Engl J Med. 2006;355(25):2664-9. DOI: 10.1056/NEJMra054785

17. Talyshinskii A.E., Guliev B.G., Mishvelov A.E., Agagyulov M.U., Andriyanov A.A. Virtual reality simulator for developing spatial skills during retrograde intrarenal pyeloscopy. Urology Herald. 2023;11(1):100-107. (In Russian). DOI: 10.21886/2308-6424-2023-11-1-100-107

18. Bozzini G, Maltagliati M, Berti L, Vismara R, Sanguedolce F, Crisci A, Fiore GB, Redaelli A, Pastore AL, Gozen A, Breda A, Scoffone C, Ahmed K, Mueller A, Gidaro S, Liatsikos E. Development and Validation of a Novel Skills Training Model for PCNL, an ESUT project. Acta Biomed. 2022;93(4):e2022254. DOI: 10.23750/abm.v93i4.11821

19. 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(7):1098-1117. DOI: 10.1089/end.2020.0408

20. Kyriazis I, Kallidonis P, Kyrkopoulou E, Spinos T, Liatsikos E. Hands on wet lab and live surgery training in PCNL: Any impact to surgical skills of attending surgeons? Arch Ital Urol Androl. 2022;94(3):300-304. DOI: 10.4081/aiua.2022.3.300

21. Favorito LA, Logsdon NT. Editorial Comment: Validity of a patient-specific percutaneous nephrolithotomy (PCNL) simulated surgical rehearsal platform: impact on patient and surgical outcomes. Int Braz J Urol. 2022;48(4):724-725. DOI: 10.1590/S1677-5538.IBJU.2022.04.03