Adopting Ultrasound Guidance for Prone Percutaneous Nephrolithotomy: Evaluating the Learning Curve for the Experienced Surgeon

作者：Usawachintachit Manint; Masic Selma; Allen Isabel E; Li Jianxing; Chi Thomas^*

来源：Journal of Endourology, 2016, 30(8): 856-863.

DOI：10.1089/end.2016.0241

Objectives: To define the learning curve associated with adopting ultrasound guidance for prone percutaneous nephrolithotomy (PCNL) for the experienced surgeon.
Methods: A prospective cohort study of consecutive patients undergoing PCNL with ultrasound guidance for renal tract access and dilation was performed. Clinical data reviewed included success in gaining renal access with ultrasound guidance, total fluoroscopic screening time, and radiation exposure dose. PCNL cases performed with fluoroscopic guidance matched for stone size served as control cases.
Results: One hundred consecutive ultrasound-guided procedures performed by a single experienced endourologist were divided into five experience groups. Significant improvement in renal access success rate with ultrasound was seen after 20 cases (p < 0.05). Total fluoroscopic screening time, radiation exposure dose, and operative time were also statistically significantly improved over the study period. When compared with fluoroscopy-guided PCNL, significant decreases in total fluoroscopic screening time (33.4 +/- 35.3 seconds vs 157.5 +/- 84.9 seconds, p < 0.05) and radiation exposure (7.0 +/- 8.7mGy vs 47.8 +/- 45.9 mGy, p < 0.05) were seen. No differences in complication rates were found.
Conclusions: Ultrasound-guided renal access for PCNL can be performed effectively after 20 cases. Transition to the use of ultrasound will quickly reduce radiation exposure for patients and intraoperative personnel.

• 出版日期2016-8