Training in percutaneous nephrolithotomy: A structured apprenticeship program

• Main Authors: Rajendra B Nerli, Shishir Devaraju, Murigendra B Hiremath
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2014-01-01
• Series: Journal of the Scientific Society
• Subjects: Apprenticeship; percutaneous surgery; training; urinary stones
• Online Access: http://www.jscisociety.com/article.asp?issn=0974-5009;year=2014;volume=41;issue=1;spage=26;epage=31;aulast=Nerli

Introduction: Percutaneous nephrolithotomy (PCNL) achieves excellent stone-free rates with acceptable complication rates and is therefore the treatment of choice for large renal calculi. It is generally believed that the establishment of a proper access tract is the crucial step. It is also well-known that PCNL is a difficult surgical technique with reported long learning curves. Apprenticeship is the traditional way of acquiring surgical skills. We report our experience in structured apprenticeship training in PCNL at our center. Materials and Methods: During the study period July 2007 to June 2012, the residents were introduced to a structured apprenticeship training program in PCNL. Results: During the study period, five residents underwent this structured apprenticeship learning. Stone clearance rate of 85.54 ± 2.67 was achieved by all the residents. The stone clearance rate for solitary renal pelvic calculi was 100%. Secondary procedures were required in 15.27 ± 2.74 of cases, blood transfusion rates were 15.2 ± 3.2, and the complication rate was 8.55 ± 1.6. Using the surgical surrogate of operation theatre time and fluoroscopy time, it was observed that competence in PCNL was obtained after 21 cases. Conclusions: Today in the absence of cheap and effective alternative training systems, structured apprenticeship training under the supervision of dedicated trainers is an effective way to train trainees. This helps in reducing the learning curve of the trainees.