Ultrasound-guided total visual access establishment for percutaneous nephrolithotomy skill acquisition by junior surgeons: a preliminary study

doi:10.3877/cma.j.issn.1674-0785.2025.12.002

Abstract

Abstract:

Objective

To investigate the role of ultrasound-guided total visual access establishment for percutaneous nephrolithotomy (PCNL) skill acquisition by junior surgeons and to establish a novel auxiliary learning method for PCNL.

Methods

A retrospective analysis was conducted on the surgical outcomes of PCNL performed by 10 novice urologists using ultrasound-guided conventional access establishment (CAE) and total visual access establishment (VAE) from January 2022 to December 2024, respectively. Items related to PCNL learning such as access establishment success, access establishment time, operation time, hemoglobin decrease, surgery success rate at 1 month postoperatively was evaluated.

Results

One hundred and ninety cases were included. In the CAE group (100 cases), 18 cases failed to establish percutaneous renal access, while 6 failed in the VAE group (90 cases). The 24 cases with failed access establishment in both groups were excluded. The access establishment success rate in the CAE group was significantly lower than that of the VAE group [82% (82/100) vs 93.3% (84/90); P＜0.05]. Access establishment time in the CAE group was significantly longer than that of the VAE group (7.2±1.4 min vs 4.9±1.0 min, P＜0.05). Operation time in the CAE group was significantly longer than that of the VAE group (60.6±56.8 min vs 43.2±10.0 min, P＜0.05). Hemoglobin decrease on the first day after surgery in the CAE group was significantly higher than that of the VAE group (13.1±4.5 g/L vs 9.1±1.4 g/L, P＜0.05). The rate of postoperative Clavien-Dindo Ⅲ/Ⅳ complications in the CAE group was significantly higher than that of the VAE group [6.1% (5/82) vs 0% (0/90), P＜0.05].

Conclusion

Ultrasound-guided total visual access establishment may improve PCNL success rate and safety for novice urologists, establishing a promising new learning aid for beginners.

Key words: Kidney stones, Percutaneous nephrolithotrips, Learning curving, Visual puncture, Visual balloon dilation

Jiqing Zhang, Xin Wang, Wei Tang, Guiqian Liu, Jiaxing Zhang, Ye Lei, Jiahui Zhao, Baoan Hong, Yuxuan Bo, Ning Zhang. Ultrasound-guided total visual access establishment for percutaneous nephrolithotomy skill acquisition by junior surgeons: a preliminary study[J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(12): 886-891.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2025.12.002

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Figures/Tables 4

	CAE	VAE	P值
年龄（岁， $x ¯$ ±s）	53.7±12.5	54.3±9.0	0.710
性别（男性/女性）	47/35	50/34	0.773
BMI	26.6±2.1	27.3±2.9	0.063
结石分布（左/右）	50/32	57/27	0.684
结石大小（cm， $x ¯$ ±s）	2.6±0.5	2.7±0.4	0.425
CT值（Hu， $x ¯$ ±s）	1040±232	1077±223	0.304

	CAE	VAE	P值
年龄（岁， $x ¯$ ±s）	53.7±12.5	54.3±9.0	0.710
性别（男性/女性）	47/35	50/34	0.773
BMI	26.6±2.1	27.3±2.9	0.063
结石分布（左/右）	50/32	57/27	0.684
结石大小（cm， $x ¯$ ±s）	2.6±0.5	2.7±0.4	0.425
CT值（Hu， $x ¯$ ±s）	1040±232	1077±223	0.304

	CAE	VAE	P值
穿刺肾盏[例（%）]			0.187
上盏	27（32.9）	36（42.9）
中盏	55（67.1）	48（57.1）
建立通道时间（min， $x ¯$ ±s）	7.2±1.4	4.9±1.0	0.001
建立通道成功率（%）	82（82/100）	93.3（84/90）	0.019
血红蛋白下降（g/L， $x ¯$ ±s）	13.1±4.5	9.1±1.4	0.001
内镜手术时间（min， $x ¯$ ±s）	60.6±56.8	43.2±10	0.006
术后住院时间（d）	4（3~9）	3（2~5）	0.001
术后1月手术成功率[例（%）]	73.2（60/82）	86.9（73/84）	0.027

	CAE	VAE	P值
穿刺肾盏[例（%）]			0.187
上盏	27（32.9）	36（42.9）
中盏	55（67.1）	48（57.1）
建立通道时间（min， $x ¯$ ±s）	7.2±1.4	4.9±1.0	0.001
建立通道成功率（%）	82（82/100）	93.3（84/90）	0.019
血红蛋白下降（g/L， $x ¯$ ±s）	13.1±4.5	9.1±1.4	0.001
内镜手术时间（min， $x ¯$ ±s）	60.6±56.8	43.2±10	0.006
术后住院时间（d）	4（3~9）	3（2~5）	0.001
术后1月手术成功率[例（%）]	73.2（60/82）	86.9（73/84）	0.027

	CAE组	VAE组	P值
并发症	11（9/82）	3.6（3/84）	0.078
Clavien-Dindo grade Ⅰ/Ⅱ	4.9（4/82）	3.6（3/84）	0.718
Clavien-Dindo grade Ⅲ/Ⅳ	6.1%（5/82）	0（0/84%）	0.028

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