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

Area of Science:

• Urology
• Surgical Techniques
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Optimizing access techniques is crucial for improving PCNL outcomes.
• The simplified biplanar (0-90º) fluoroscopic puncture technique offers a novel approach to renal access.

Purpose of the Study:

• To evaluate the learning curve associated with the simplified biplanar (0-90º) fluoroscopic puncture technique for PCNL.
• To assess the time required for fellows to achieve proficiency in this technique.
• To compare fellow performance with that of an experienced surgeon.

Main Methods:

• Prospective evaluation of patients undergoing PCNL using the simplified biplanar (0-90º) technique by fellows.
• Assessment of learning curve via fluoroscopic screening time and renal puncture time.
• Comparison of fellow data with a control group operated by a senior surgeon.

Main Results:

• Eighty-nine patients were analyzed, with homogeneous demographic data across groups.
• Fellows required an average of 10 procedures to match the senior surgeon's mean puncture time (p=0.046).
• Fluoroscopic screening times for puncture were comparable to the senior surgeon even before completing 10 procedures.

Conclusions:

• The simplified biplanar (0-90º) puncture technique demonstrates a brief learning curve regarding fluoroscopic screening time.
• Novice fellows may need approximately 10 cases to master puncture time for complex renal stones.
• Proficiency in puncture time for simple renal stones is achieved rapidly with this technique.