Tendencias de punción extrapapilar en nefrolitotomía percutánea. Revisión de la literatura / Percutaneous nephrolithotomy non–papiilary puncture trends. A review of the literature

La nefrolitotomía percutánea (NLPC) es el tratamiento de referencia para los cálculos renales de gran tamaño. Aunque tradicionalmente la punción dirigida a la papila renal ha sido la piedra angular de este tratamiento, se han desarrollado tendencias de punción en sitios distintos de la papila renal que han despertado interés en este contexto. El objetivo de este estudio es investigar la evolución del acceso extrapapilar para la NLPC a lo largo de los años. Se realizó una revisión de la literatura y se incluyeron 13 publicaciones en el estudio. Se encontraron 2estudios experimentales que investigaban la viabilidad del acceso extrapapilar, 5estudios prospectivos de cohortes, 2retrospectivos sobre el acceso extrapapilar y 4estudios que comparaban el acceso papilar con el extrapapilar. La técnica de acceso extrapapilar ha demostrado ser una solución segura y eficaz capaz de adaptarse a las últimas tendencias endoscópicas. El uso generalizado de esta técnica es previsible en el futuro. (AU)

Percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal calculi. Papillary puncture is the mainstay of treatment for large renal calculi, but the non-papilary has been introduced and gained some interest. The aim of this study is the investigation of trends of non-papillary access for PCNL over the years. A review of the literature took place and 13 publications were included in the study. Two experimental studies investigating the feasibility of non-papillary access were found. Five cohort prospective and 2retrospective studies for non-papillary access and 4comparative studies between papillary and non-papillary access were included. Non papillary access is a technique that has been proved as a safe and efficient solution that keeps up with the latest endoscopic trends. A wider use of this method could be expected in the future. (AU)

Percutaneous nephrolithotomy non-papillary puncture trends. A review of the literature.

Percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal calculi. Papillary puncture is the mainstay of treatment for large renal calculi, but the non-papillary has been introduced and gained some interest. The aim of this study is the investigation of trends of non-papillary access for PCNL over the years. A review of the literature took place and 13 publications were included in the study. Two experimental studies investigating the feasibility of non-papillary access were found. Five cohort prospective and 2 retrospective studies for non-papillary access and 4 comparative studies between papillary and non-papillary access were included. Non papillary access is a technique that has been proved as a safe and efficient solution that keeps up with the latest endoscopic trends. A wider use of this method could be expected in the future.

Transferencia de habilidades prácticas desde el laboratorio a cirugía in vivo utilizando el sistema robótico Avatera: Estudio experimental / Transfer of acquired practical skills from dry lab into live surgery using the Avatera robotic system: an experimental study

Objetivo Evaluar la transferencia de habilidades adquiridas en el laboratorio a un entorno experimental real para realizar cirugía robótica. Material y métodos Se utilizó un modelo experimental in vivo. Seis residentes y fellows de urología; dos R2 sin exposición previa a cirugía laparoscópica (Grupo 1), dos R4 con exposición intermedia (Grupo 2) y dos fellows formados en cirugía laparoscópica (Grupo 3) realizaron reimplantes ureterales distales, pieloplastia, y nefrectomía radical en tres cerdos hembra. Previamente a realizar los procedimientos, cada participante completó entre 10 y 14 h de formación en cirugía robótica en laboratorio hasta adquirir habilidades para realizar maniobras quirúrgicas básicas (sutura, corte y paso de agujas). Las variables analizadas fueron completar o no con éxito los procedimientos, el tiempo de consola y el tiempo para realizar las maniobras solicitadas y. presencia de complicaciones. Resultados Los tres grupos completaron con éxito todos los procedimientos excepto la pieloplastia, que no la completó el Grupo 1 por sangrado de la vena renal. El Grupo 3 logró un tiempo de consola más corto para todos los procedimientos y para los pasos quirúrgicos por separado, seguido por el Grupo 2. El grupo más lento para completar los procedimientos y los pasos fue el Grupo 1. Conclusiones A pesar de que es necesaria evidencia clínica al respecto, nuestros resultados sugieren que los procedimientos urológicos con asistencia robótica y los pasos más difíciles técnicamente podrían realizarse de manera segura y efectiva después de un entrenamiento adecuado en el laboratorio bajo la supervisión de un mentor. (AU)

Objective To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. Material and methods An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 hours dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. Results All procedures were completed successfully by all groups except the pyeloplasty by Group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. Conclusions Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study. (AU)

Transfer of acquired practical skills from dry lab into live surgery using the avatera robotic system: An experimental study.

OBJECTIVE: To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. MATERIAL AND METHODS: An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. RESULTS: All procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. CONCLUSIONS: Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.

Non papillary mini-percutaneous nephrolithotomy: early experience.

PURPOSE: This study aims to evaluate the non-papillary puncture for mini-PCNL in terms of safety and efficacy. METHODS: A total number of 32 patients were subjected to mini-PCNL by the performance of non-papillary punctures over 6 months. One-step track dilation to 22 Fr took place in all cases. An 18 Fr nephroscope (Slender, Karl Storz GmbH, Germany) and an ultrasound lithotripter (Lithoclast Master, EMS S.A, Switzerland) with 9.9 Fr probe was used. Demographics and perioperative data are prospectively collected from an institutional board-approved database and the presented data were retrospectively collected. RESULTS: The average cumulative stone size was 23.53 ± 6.6 mm. Mean operative time was 44.6 ± 13.44 min and primary stone-free rate after PCNL was 96% and 85.7% for single and multiple access, respectively. Second access was performed in seven cases, all of which had multiple stones. Mean hemoglobin drop was 1.23 ± 0.88 gr/dL. The patients stayed 2.56 ± 0.98 days in the hospital. Overall complication rate was 9.37%, without encountering any severe bleeding complication. CONCLUSION: Using non-papillary access for mini-PCNL did not result in significant blood loss and need for transfusions. The respective data were directly comparable to contemporary literature and the safety of mini-PCNL by a non-papillary approach could be advocated.