Noureldin Yasser A, Elkoushy Mohamed A, Andonian Sero
Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC; ; Department of Urology, Benha University Hospital, Benha University, Benha, Egypt;
Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC; ; Department of Urology, Suez Canal University, Ismailia, Egypt.
Can Urol Assoc J. 2015 Mar-Apr;9(3-4):E104-8. doi: 10.5489/cuaj.2482.
The first objective was to assess percutaneous renal access (PCA) skills of urology postgraduate trainees (PGTs) during the Objective Structured Clinical Examinations (OSCEs). The second objective was to determine whether previous experience with percutaneous nephrolithotomy (PCNL) improved performance.
After obtaining ethics approval, we recruited PGTs from two urology programs in Quebec between postgraduate years (PGY-3 to PGY-5). Each trainee was asked to answer a short questionnaire regarding previous experience in endourologic procedures. After a 3-minute orientation on the PERC Mentor simulator (Simbionix, Cleveland, OH), each trainee was asked to perform task 4, where they had to correctly access all of the renal calyces and pop the balloons in a normal left kidney model. We collected and analyzed data from the questionnaire and the performance report generated by the simulator.
In total, 13 PGTs participated in this study. PGTs had performed a median of 200 (range: 50-1000) cystoscopies, 50 (range: 10-125) TURBTs, 30 (range: 0-100) TURPs, 5 (range: 0-50) laser prostatectomies, and 50 (range: 2-125) ureteroscopies prior to this OSCE. PGTs with previous PCNL experience (8/13) had performed a mean of 18.6 ± 6.3 PCNLs. PGTs with previous PCNL experience performed significantly better in terms of shorter fluoroscopy time (10 ± 1.5 vs. 5.1 ± 0.7 min; p = 0.04), fewer attempts required for successful puncture of the pelvi-calyceal system (PCS) (21 ± 2.3 vs. 13 ± 1.8; p = 0.02), and had significantly lower complications in terms of fewer infundibular injury (7.4 ± 1.5 vs. 2 ± 0.4; p = 0.004) and fewer PCS perforations (11 ± 1.7 vs. 4.5 ± 1.2; p = 0.01).
It is feasible to use the PERC Mentor simulator during OSCEs to assess PCA skills of urology PGTs. PGTs who had previous PCNL experience performed significantly better with fewer complications.
首要目标是在客观结构化临床考试（OSCEs）期间评估泌尿外科研究生学员（PGTs）的经皮肾穿刺入路（PCA）技能。第二个目标是确定既往经皮肾镜取石术（PCNL）经验是否能提高操作表现。
获得伦理批准后，我们从魁北克的两个泌尿外科项目中招募了研究生学员（PGY - 3至PGY - 5）。每位学员被要求回答一份关于既往腔内泌尿外科手术经验的简短问卷。在对PERC Mentor模拟器（Simbionix，俄亥俄州克利夫兰）进行3分钟的操作介绍后，要求每位学员执行任务4，即在正常左肾模型中正确穿刺所有肾盏并刺破球囊。我们收集并分析了问卷数据以及模拟器生成的操作表现报告。
共有13名PGTs参与了本研究。在此次OSCE之前，PGTs进行膀胱镜检查的中位数为200次（范围：50 - 1000次），经尿道膀胱肿瘤切除术（TURBT）50次（范围：10 - 125次），经尿道前列腺电切术（TURP）30次（范围：0 - 100次），激光前列腺切除术5次（范围：0 - 50次），输尿管镜检查50次（范围：2 - 125次）。有既往PCNL经验的PGTs（8/13）平均进行了18.6 ± 6.3次PCNL。有既往PCNL经验的PGTs在以下方面表现明显更好：透视时间更短（10 ± 1.5分钟对5.1 ± 0.7分钟；p = 0.04），成功穿刺肾盂 - 肾盏系统（PCS）所需的尝试次数更少（21 ± 2.3次对13 ± 1.8次；p = 0.02），并且并发症显著更低，包括更少的肾小盏损伤（7.4 ± 1.5次对2 ± 0.4次；p = 0.004）和更少的PCS穿孔（11 ± 1.7次对4.5 ± 1.2次；p = 0.01）。
在OSCEs期间使用PERC Mentor模拟器评估泌尿外科PGTs的PCA技能是可行的。有既往PCNL经验的PGTs表现明显更好，并发症更少。
