Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
Veterinary Medicine Graduate Student, University of Franca (UNIFRAN), Franca, São Paulo, Brazil.
PLoS One. 2021 Sep 27;16(9):e0257653. doi: 10.1371/journal.pone.0257653. eCollection 2021.
The use of renal biopsy through laparoscopy is increasingly present both in human and veterinary medicine. However, both techniques require skill and training to make the operator capable to do it. The learning curve allows the quantitative and qualitative assessment of the number of attempts and minimum time for the surgical procedure. The objective included establish the learning curve for laparoscopy-guided kidney biopsy procedures in dog and pig corpses. Six dogs and six pigs corpses weighing less than 10 kg were used for this study. All corpses underwent kidney biopsy performed through laparoscopy. Twenty-four operators, two per animal, performed 20 renal biopsies each (10 for each kidney), with 480 collection-procedures in total. Duration and difficulty of the procedure and the biopsy sample quality were evaluated and statistical analysis was performed using a mixed regression model with a random effect of individuals and multivariate analysis of data. There were 91.5% of the samples that were adequate for evaluation. There was no significant difference in the number of glomeruli or cortex percentage considering the attempts in either species, demonstrating the operator's ability since first collection. Swine samples showed higher amounts of renal cortex than canine samples. The procedure duration was shorter as more attempts were performed in dogs and pigs. From the fourth repetition, the professional reached a plateau for the variable related to 'collection', and from the second, the professional presented uniform duration for 'sample storage'. Operators of the swine model acquired more agility than the dog ones. The variable 'difficulty' decreased as more repetitions were performed, reaching a plateau in the sixth attempt. Seven renal biopsies laparoscopy-guided are required for an operator to be considered 'capable' to perform the procedure in the referred species included. The learning curve for image-guided kidney biopsy procedures improves the implementation of this technique and benefits patients that undergo this procedure.
在人类和兽医医学中，通过腹腔镜进行肾活检的应用越来越多。然而，这两种技术都需要技巧和培训，以使操作者能够进行操作。学习曲线允许对尝试的次数和手术程序的最短时间进行定量和定性评估。本研究的目的是确定狗和猪尸体的腹腔镜引导下肾活检程序的学习曲线。使用了六只狗和六只体重小于 10 公斤的猪尸体进行本研究。所有尸体均接受了通过腹腔镜进行的肾活检。24 名操作员（每只动物 2 名）每人进行了 20 次肾脏活检（每只肾脏 10 次），总共进行了 480 次采集程序。评估了程序的持续时间和难度以及活检样本的质量，并使用具有个体随机效应的混合回归模型和数据的多变量分析进行了统计分析。有 91.5%的样本足以进行评估。在两种动物中，考虑到尝试次数，肾小球的数量或皮质百分比没有差异，这证明了操作者的能力从第一次采集开始。猪样本的肾皮质量高于犬样本。随着尝试次数的增加，程序持续时间更短。在狗和猪中，从第四次重复开始，专业人员在与“采集”相关的变量中达到了一个平台，从第二次重复开始，专业人员的“样本存储”持续时间均匀。猪模型的操作员比狗模型的操作员更敏捷。随着重复次数的增加，变量“难度”降低，并在第六次尝试时达到平台期。对于所包括的参考物种，操作者需要进行七次腹腔镜引导的肾活检，才能被认为能够进行该程序。图像引导的肾活检程序的学习曲线可改善该技术的实施，并使接受该程序的患者受益。
