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Simplified biplanar (0–90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve

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Abstract

Purpose

To evaluate the learning curve of the simplified fluoroscopic biplanar (0–90º) puncture technique for percutaneous nephrolithotomy.

Methods

We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution’s fellows employing the simplified bi-planar (0–90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon.

Results

Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon.

Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures.

Conclusion

This study suggests that with the simplified biplanar (0–90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

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Acknowledgements

We appreciate all the support of the actual HRAEB’s fellows, MD Pompeyo Alarcon and Edson Flores.

Funding

This paper received no funding.

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Authors and Affiliations

  1. Endourology Deparment, Hospital Regional de Alta Especialidad Del BajíoLeon, Boulevard Campestre #306 Int 410, CP: 37160, León, Gto, Mexico

    B. O. Manzo, J. E. Torres, J. D. Cabrera & H. M. Sanchez

  2. Department of Clinical Research, HRAEB, Leon, Gto, Mexico

    E. Lozada

  3. Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain

    E. Emiliani

  4. Universidade Federal Da Bahia and Hospital da Mulher da Bahia, Salvador, Brazil

    F. Sepulveda

  5. Urology Department, Hospital Parroquial, San Bernardo and Universidad de Los Andes, Santiago, Chile

    C. Morales & I. Morales

Authors
  1. B. O. Manzo
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  2. J. E. Torres
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  3. J. D. Cabrera
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  4. E. Lozada
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  5. E. Emiliani
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  6. F. Sepulveda
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  7. C. Morales
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  8. I. Morales
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  9. H. M. Sanchez
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Contributions

MBO: protocol/project development, data collection or management, manuscript writing/editing. TJE: protocol/project development, data collection. CJD: protocol/project development, data collection. LE: data collection or management and data analysis. EE: protocol/project development, manuscript writing/editing. SF: protocol/project development. MC: protocol/project development. MI: protocol/project development. SHM: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to B. O. Manzo.

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Conflict of interest

All the authors declare no conflict of interest.

Ethical approval

The ethics committee approved the present study of the institution with the Number: CI/HRAEB/2018/28.

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Manzo, B.O., Torres, J.E., Cabrera, J.D. et al. Simplified biplanar (0–90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve. World J Urol 39, 3657–3663 (2021). https://doi.org/10.1007/s00345-021-03669-7

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  • DOI: https://doi.org/10.1007/s00345-021-03669-7

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