具有调节肾脏和骨骼地标位置能力的非生物模拟器:用于经皮肾镜碎石术的穿刺训练

B. Guliev, A. Talyshinskiy, E. O. Stetsik, M. Agagyulov
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摘要

介绍。文献中提出的非生物模拟器与真实的人体解剖结构相差甚远,其主要目的是在不可能模仿各种术中场景的情况下,发展肾盂局部系统(PCS)穿刺技能。研究目的:描述超声引导PCS穿刺模拟器的制造和初始测试,该模拟器具有任意放置骨地标和肾脏模型,以及在PCS穿刺过程中使用逆行视图。材料和方法。该研究包括对5名住院医师和2名泌尿科医生的培训。每位参与者使用18号超声引导针穿刺5次。比较了形成通路的尝试次数、穿刺时间及其正确性(通过乳头刺入小花萼)以及确定目标花萼的正确性。使用半刚性输尿管镜逆行评估针的轨迹,并使用我们的移动应用程序评估所选肾萼的解剖鉴定。住院医生和泌尿科医生的总尝试次数分别为49次和14次。穿刺步骤的平均持续时间为25.2秒和12.0秒。在9/25的病例中,居民能够正确分析视觉超声信息以确定目标花萼。经63次穿刺后注入造影剂,未见造影剂渗漏。建议的PCS穿刺模拟器允许开发开发所有必要的技能,为经皮穿刺技术的年轻泌尿科医生提供经济有效的培训。
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The non-biological simulator with the ability to regulate the position of the kidney and bone landmarks: use for training puncture access in percutaneous nephrolithotripsy
Introduction. The non-biological simulators presented in the literature are far from the real human anatomy and are primarily aimed at developing the skill of the pyelocalyceal system (PCS) puncture without the possibility of imitating various intraoperative scenarios.Purpose of the study. To describe the manufacturing and initial testing of the ultrasound-guided PCS puncture simulator with arbitrary placement of bone landmarks and a kidney model, along with the use of a retrograde view during PCS puncture.Materials and methods. This study included training for 5 resident and 2 urologists. Each participant performed the puncture 5 times using an 18-gauge ultrasound-guided needle. A comparison was made between the number of attempts to form access, the duration of the puncture and its correctness (puncture into the small calyx through the papilla), as well as the correctness of determining the target calyx. The trajectory of the needle was retrogradely assessed using a semi-rigid ureteroscope, and the anatomical identification of the selected calyx was assessed using our mobile application.Results. The total number of attempts was 49 and 14 among residents and urologists, respectively. The average duration of the puncture step was 25.2 and 12.0 seconds. In 9/25 cases, residents were able to correctly analyze visual ultrasound information to determine the target calyx. When a contrast agent was injected into the PCS after 63 punctures, no contrast leakage was found.Conclusion. The proposed PCS puncture simulator allows to develop to develop all the necessary skills for cost-effective training of young urologists in the technique of percutaneous access.
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