Which renal access technique for PCNL is more difficult to teach using simulation?

Area of Science:

• Urology
• Surgical Simulation
• Medical Education

Background:

• Percutaneous nephrolithotomy (PCNL) is a crucial skill for urology residents.
• Simulation training, like with the PERC Mentor, offers a safe environment for developing PCNL skills.
• Two primary fluoroscopic methods for renal access are triangulation and bull's eye.

Purpose of the Study:

• To compare the ease of teaching the triangulation versus bull's eye method for PCNL access to novices using a simulator.
• To evaluate subjective and objective outcomes for each method.

Main Methods:

• Fifteen novice trainees were randomized to learn and perform both triangulation and bull's eye methods using the PERC Mentor simulator.
• Training included written, video, and in-person demonstrations, followed by hands-on practice.
• Objective performance data from the simulator and subjective Global Rating Scale (GRS) scores were collected.

Main Results:

• No significant difference in overall outcomes or complication rates was observed between the two methods.
• The bull's eye method demonstrated a statistically significant reduction in operative time (128s vs. 91s) and fluoroscopy time (123s vs. 87s) compared to the triangulation method.
• Trainees acquired both techniques with similar proficiency.

Conclusions:

• Both the triangulation and bull's eye methods for PCNL access are equally well-learned by novice trainees.
• While outcomes are similar, the bull's eye method offers efficiency gains in operative and fluoroscopy time for beginners.
• Simulation-based training effectively teaches PCNL renal access techniques.