Huri Emre, Skolarikos Andreas, Tatar İlkan, Binbay Murat, Sofikerim Mustafa, Yuruk Emrah, Karakan Tolga, Sargon Mustafa, Demiryurek Deniz, Miano Roberto, Bagcioglu Murat, Ezer Mehmet, Cracco Cecilia Maria, Scoffone Cesare Marco
Faculty of Medicine, Urology Department, Hacettepe University, Sıhhiye-Ankara, Turkey.
Urology Department, Athens Medical School, Athens, Greece.
World J Urol. 2016 May;34(5):741-6. doi: 10.1007/s00345-015-1676-3. Epub 2015 Aug 30.
The aim of the current study was to evaluate the use of fresh-frozen concurrently with embalmed cadavers as initial training models for flexible ureteroscopy (fURS) in a group of urologists who were inexperienced in retrograde intrarenal surgery (RIRS).
Twelve urologists involved in a cadaveric fURS training course were enrolled into this prospective study. All the participants were inexperienced in fURS. Theoretical lectures and step-by-step tips and tricks video presentations on fURS were used to incorporate the technical background of the procedure to the hands-on-training course and to standardize the operating steps of the procedure. An 8-item survey was administered to the participants upon initiation and at the end of the course.
Pre- and post-training scores were similar for each question. All the participants successfully completed the hands-on-training tasks. Mean pre-training duration [3.56 ± 2.0 min (range 1.21-7.46)] was significantly higher than mean post-training duration [1.76 ± 1.54 min (range 1.00-6.34)] (p = 0.008). At the end of the day, the trainers checked the integrity of the collecting system both by endoscopy and by fluoroscopy and could not detect any injury of the upper ureteral wall or pelvicalyceal structures. The functionality of the scopes was also checked, and no scope injury (including a reduction in the deflection capacity) was noted.
The fURS simulation training model using soft human cadavers has the unique advantage of perfectly mimicking the living human tissues. This similarity makes this model one of the best if not the perfect simulator for an effective endourologic training.
本研究旨在评估在一组逆行肾内手术（RIRS）经验不足的泌尿外科医生中，将新鲜冷冻尸体与防腐尸体同时用作软性输尿管镜检查（fURS）初始训练模型的情况。
参与尸体fURS培训课程的12名泌尿外科医生被纳入这项前瞻性研究。所有参与者均无fURS经验。通过fURS的理论讲座以及逐步的操作技巧视频演示，将该手术的技术背景融入实践培训课程，并规范手术操作步骤。在课程开始时和结束时，对参与者进行了一项包含8个项目的调查。
每个问题的培训前和培训后得分相似。所有参与者均成功完成了实践培训任务。培训前平均时长[3.56 ± 2.0分钟（范围1.21 - 7.46）]显著高于培训后平均时长[1.76 ± 1.54分钟（范围1.00 - 6.34）]（p = 0.008）。在当天结束时，培训人员通过内镜检查和荧光透视检查了集合系统的完整性，未发现输尿管上段壁或肾盂肾盏结构有任何损伤。还检查了输尿管镜的功能，未发现输尿管镜损伤（包括偏转能力下降）。
使用柔软人体尸体的fURS模拟训练模型具有完美模拟人体活体组织的独特优势。这种相似性使其成为有效腔内泌尿外科培训的最佳模拟器之一（即便不是完美的模拟器）。
