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Training in percutaneous nephrolithotomy--a critical review
Jean J M C H de la Rosette1, Maria P Laguna, Jens J Rassweiler
1Department of Urology, AMC University Hospital, Amsterdam, The Netherlands. j.j.delarosette@amc.uva.nl
European Urology
|April 9, 2008
Summary
Percutaneous nephrolithotomy (PCNL) training is challenging, particularly renal access. Achieving surgical expertise requires over 100 procedures, highlighting the need for dedicated training centers and advanced simulators.
Area of Science:
- Urology
- Surgical Education
- Medical Simulation
Background:
- Percutaneous nephrolithotomy (PCNL) is a complex endourological procedure for renal stone management.
- Effective training and skill maintenance are critical for PCNL proficiency.
Purpose of the Study:
- To identify key factors influencing the training and skill maintenance in percutaneous nephrolithotomy (PCNL).
Main Methods:
- Systematic literature search across Medline, MeSH, and Cochrane databases using keywords related to renal stones, PCNL, and surgical training.
- Defined levels of evidence based on ICUD and WHO recommendations.
Main Results:
- Renal access is the most critical factor in PCNL training, with proficiency requiring approximately 24 procedures.
- Competence is achieved after 60 cases, and excellence after over 100 cases.
- Virtual reality simulators show potential for PCNL training; continuing education is vital for maintaining expertise.
Conclusions:
- PCNL is the most challenging stone surgery technique to teach due to its steep learning curve, primarily in renal access.
- Apprenticeship remains the traditional training method in the absence of validated virtual simulators.
- Centralized treatment in dedicated stone centers may optimize renal stone management.
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