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Ureteral access sheath insertion forces: implications for design and training.

Renato N Pedro1, Derek Weiland, Scott Reardon

  • 1Departments of Urologic Surgery, State University of Campinas, UNICAMP, Sao Paulo, Brazil. rnpedro@gmail.com

Urological Research
|March 30, 2007
PubMed
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Experienced urologists apply significantly more force when inserting ureteral access sheaths (UAS) than residents. This data helps establish training benchmarks for UAS placement and informs device design.

Area of Science:

  • Urology
  • Medical Device Engineering
  • Surgical Simulation

Background:

  • Ureteral access sheaths (UAS) are crucial for ureteroscopic procedures.
  • The forces exerted during UAS insertion can impact patient safety and device integrity.
  • Variability in insertion forces may affect the design of UAS and ureteroscopic simulators.

Purpose of the Study:

  • To quantify the peak insertion forces applied during simulated ureteral access sheath placement.
  • To compare the forces applied by experienced urologists and urology residents.
  • To provide data for the design of improved UAS and training simulators.

Main Methods:

  • A model UAS was subjected to simulated insertion by 8 urologists and 5 residents.
  • Peak compression forces were measured using a digital force gauge.

Related Experiment Videos

  • Participants were instructed to stop upon feeling significant resistance.

    • Main Results:

    • Urologists applied a mean maximum force of 6.55 N, while residents applied 4.84 N (P = 0.035).
    • No significant difference was found in the variance of forces between the groups (P = 0.11).
    • No significant difference in applied force was observed across repeated attempts (P = 0.80).

    Conclusions:

    • Experienced urologists exert greater force during UAS insertion compared to residents.
    • These findings are critical for establishing competency parameters in urology training.
    • The data can inform the development of more robust UAS and realistic ureteroscopic simulators.