Sfoungaristos Stavros, Lorber Amitay, Gofrit Ofer N, Yutkin Vladimir, Landau Ezekiel H, Pode Dov, Duvdevani Mordechai
Department of Urology, Haddasah Hebrew University Medical Center, Jerusalem, Israel,
Urolithiasis. 2015 Aug;43(4):369-74. doi: 10.1007/s00240-015-0774-4. Epub 2015 Apr 18.
The purpose of this study was to identify parameters that affect fluoroscopy time during ureteroscopy or retrograde intrarenal surgery (RIRS) and to evaluate the potential role of surgical experience gained during a fellowship program in decreasing radiation exposure. A database of patients who underwent ureteroscopy or RIRS was evaluated. Procedures were performed either by an experienced Endourologist (surgeon A) or by an Endourology fellow. Operations performed by the fellow were further divided to them performed during fellow's 1st year of training (surgeon F1) and 2nd year of training (surgeon F2). The association between fluoroscopy time and several factors was evaluated. Eighteen (19.6%) procedures were performed by surgeon F1, 13 (14.1%) by surgeon F2 and 61 (66.3%) cases were performed by surgeon A. Fluoroscopy time was significantly higher in cases performed by surgeon F1 compared to surgeon F2 (p=0.025) and A (p=0.001). However, there was no difference between surgeon F2 and A (p=0.969). There was significant association between fluoroscopy time and obesity (p=0.023), stone size (p=0.009), surgical experience (p=0.001), procedure duration (p<0.001) and the insertion of a postoperative double-J stent (p<0.001). Multivariate analysis showed that procedure duration (p=0.003), postoperative stenting (p=0.009) and surgeon's experience (p<0.001) were all significant independent predictors of increased fluoroscopy time. Fluoroscopy time may widely vary during ureteroscopy and RIRS. Procedure duration, the insertion of a postoperative double-J stent and surgical experience are all independent predictors of increased fluoroscopy time.
本研究的目的是确定影响输尿管镜检查或逆行性肾内手术（RIRS）期间透视时间的参数，并评估在进修培训项目中积累的手术经验在减少辐射暴露方面的潜在作用。对接受输尿管镜检查或RIRS的患者数据库进行了评估。手术由一位经验丰富的腔内泌尿外科医生（外科医生A）或一名腔内泌尿外科进修医生进行。进修医生进行的手术进一步分为其培训第一年（外科医生F1）和第二年（外科医生F2）进行的手术。评估了透视时间与几个因素之间的关联。外科医生F1进行了18例（19.6%）手术，外科医生F2进行了13例（14.1%），外科医生A进行了61例（66.3%）。与外科医生F2（p = 0.025）和A（p = 0.001）相比，外科医生F1进行的病例透视时间显著更高。然而，外科医生F2和A之间没有差异（p = 0.969）。透视时间与肥胖（p = 0.023）、结石大小（p = 0.009）、手术经验（p = 0.001）、手术持续时间（p < 0.001）以及术后置入双J支架（p < 0.001）之间存在显著关联。多变量分析表明，手术持续时间（p = 0.003）、术后支架置入（p = 0.009）和外科医生的经验（p < 0.001）都是透视时间增加的显著独立预测因素。输尿管镜检查和RIRS期间透视时间可能差异很大。手术持续时间、术后置入双J支架和手术经验都是透视时间增加的独立预测因素。
