Marina Borrego, n/a: No financial relationships to disclose
Carlos B. Ortiz, MD: No financial relationships to disclose
Purpose: Percutaneous nephrostomy (PCN) is a commonly performed procedure thatcan bechallengingfor trainees who lackdirect experience.We aim to utilize an ex vivo model to simulate hydronephrosis for PCN placementtraining withultrasound and fluoroscopic guidance.
Materials and Methods: Twenty porcine kidneys were harvested from a local slaughterhouse with a segment of the ureter attached. A bovine shoulder steak was placed on top of each kidney to mimicretroperitoneal tissue and increase the difficulty of the procedure. After the ureter was cannulated with a 5-Fr sheath, saline wasinjectedto dilate the collecting system and simulate hydronephrosis. Under supervision of an experienced IR physician, IR trainees and faculty attempted aPCN placement using ultrasound guidance followed by fluoroscopy guidance.An attempt was considered successful if the operator was able to puncture a calyx with a coaxial introducer system and insert an 8-Fr nephrostomy drain into the collecting system.The fluoroscopic time, radiation dose, total punctures, success (yes/no), and experience level of each operator were collected for each training session. Standard statistical analysis was performed to compare these variables by level of training and placement technique.
Results: All attempts for ultrasound guided (n=20)and fluoroscopy guided (n=20) placements were successful. IR trainee and faculty comparisons are summarized in Table 1. Average fluoroscopic time for ultrasound was 1.8±0.9minutes and 3.6 ± 2.7minutes for fluoroscopy (p < 0.01). Average radiation dose for ultrasound was 1.8 ±1.1 mGy and 4.9 ±4.1 mGy for fluoroscopy (p < 0.01). Average punctures using ultrasound were2.2±2.3and 2.6 ± 2.6 for fluoroscopy (p > 0.01).
Conclusion: This PCN training model allows for a low-risk environment for IR trainees and faculty to practice procedural skills using ultrasound and fluoroscopy guidance.