Simulation of real-time ultrasound-guided renal biopsy

Percutaneous renal biopsy has an essential role in the diagnosis and treatment of multiple kidney disorders. Unfortunately, this invasive procedure is associated with increased risk for adverse, even lethal, outcomes. Simulation training has been shown to improve procedure competencies; therefore, we developed an inexpensive simulation tool for teaching and practicing real-time ultrasound-guided percutaneous renal biopsy. This model mimics human kidney biopsy conditions in terms of kidney size, depth, tissue echogenicity, and overall structural characteristics. The preparation is simple, consisting of inserting a porcine kidney phantom under a turkey breast, using standard ultrasound imaging and semiautomatic needles, and allowing repetitive sampling. Our tool for initial renal biopsy training and for maintenance of already acquired skills has received positive feedback from fellows in major adult and pediatric nephrology training programs. Future controlled studies are needed to establish the efficacy of this simulation training in reducing discomfort and adverse renal biopsy outcomes in patients.