Download - PCNL Simulation models
Microbox white light PCNL simulator
PCNL simulators Dr Shankar Ram .Dr Aby Madan Dr Nazar M 1.Resident.2.Assistant Professor 3.Prof and HODDept of Urology .TD MCH .Alleppy .Kerala
Small Models Sinha and Krishnamoorthy
Lezrek et al
Mobile model
Twin mobile model 2
2 way swithch LED model 4
Box model
AimTo create simplest PCNLpuncture trainer & understand principles of punctureDesigning calyceal framework compatable for white light .
Introduction White light fluroscopy PCNl simulation in BOX model Portable \simple modelFirst micro model without radiation
Small Models Vegetable model sinha & Krishnamurthy et al Chinese Glove model .Lazrek M et al
Construction
Design
Lids together Bottoms together
PCS from the side wall holes Can be rotated to change the calyx direction
Resin sponge External
Making of Calyx
2. Straw bands straw1. OHP sheet
to be rolled up and banded 12
Opsite cup
Calyceal indentation and feeling of give away
Single bulb LED Keyboard light
020
Subtle difference in trajectory of conventional C arm x ray source and microbox light source arising form same angles
39
Side movement Back and forth Movement(Mediolateral)
Interpretation of Shift in C arm Rotation according to XY angle of calyx
Calyx Angle X Y
C armRotation ML CCShift
Craniopcaudal CCMediolateral rotatiopn MLSC-superio calyx IC Inferior calyx Y axis is ureter Towards SC IC
Analysis
Puncture
Calyx Direction
Shortens Lengthen Directing Towards LED Away from LED
0 - 20 degreesNeedle Superficial Needle and calyx come closer /OvershootsNeedle Deep Needle and Calyx separate apart /moves out of calyx
10 degree caudal Needele .Superficial In image Needle slips out of calyx towards LED light
Needle . Deep In image Needle slips out of calyx away from LED light
Needle outside calyx
Puncture
Image J Analysis
Response Assessment Image (J) congruence - 97.3%SD0.7 (n = 20)Understanding Triangulation Demonstration of calyx indendation Haptics Reasonable Overall comparision with c arm image
Conclusions Simple self make device will help in Understand the principles involved in calyceal puncture Shoten learning curveThis inexpensive,simple,portable model with reasonable haptics can be used for dry lab training for PCNL puncture.
Experience factor Learnt all the passages Conditioning after repeated trial and error
References References :
1. Maneesh Sinha, Venkatesh Krishnamoorthy. Use of a vegetable model as a training tool for PCNL puncture . Ind . J Urol 2015 ;31(2):156-1592. Lezrek M .Chinese shadows for initial learning of calyx puncture without radiation exposure.Urology 84 (4 Supplement 1)s158 Oct 2014.
White light C Arm for PCNL simulation.
Models Animal model Cadaver model Virtual Reality simulators Physical simulator model Simportal C Arm modelVirtual Fluroscopy model
Transparent screen punctute model
Make Easy Save Easy Learn Easy Without Radiation
66
Key challenges unique characteristics Designing simple Fulcrum for C arm Ennabling mediolateral and anteroposterior rotation Image (shadow) capture similar to conventinal c armDesign appearance similar to C arm Simple Home made prototype design
Construction
pic
BP apparatus stand Cycle rim Image ReceiverWEB cam + Paper drum Calyceal system LED Short Focus Head lightFixed to Rim Plastic Trolley PVC coupler Junction/ Fulcrum
Small PVC pipes in ball bearing arrangement within Coupler and allows steady rotation of Cycle rim (C ARM )
Coupler and Fulcrum
Paper drum captures the shadow which is perceived by web cam on the other side above
Thermocol based haptic model
Combined model
Ashish et al Transparent screen model
Triangulation
Superficial
Deep
0 - 30 degreesNeedle Superficial Needle and calyx come closer /OvershootsNeedle Deep Needle and Calyx separate apart /moves out of calyx
10 degree caudal Needele .Superficial In image Needle slips out of calyx towards LED light
Needle . Deep In image Needle slips out of calyx away from LED light
Interpretation of Shift in C arm Rotation according to XY angle of calyx
Calyx Angle X Y
C armRotation ML CCShift
Craniopcaudal CCMediolateral rotatiopn MLSC-superio calyx IC Inferior calyx Y axis is ureter Towards SC IC
Comparison of images with c arm
Image J analysis
Fixed reference points - ROIEdges ,cornersjunctions of calyx Needle tipArea measured and analysed
Response Assessment Image (J) congruence 98.4%SD0.8 (n = 10)Understanding Triangulation Understnding orientation of calyx Demonstration of calyx indendation Haptics Variable Gross Overall comparision with c arm image almost same
Conclusion The simulators help acquiring basic knowledge and skill to gain access to pelvicalyceal system andInterpretation of shadows of calyx and its relationship with that of needle in two different angles .The knowledge can be extrapolated in further learning and practice
We hypothesise that these simulators Improve the Learning curve of PCNL and eventually reduce the fluoroscopy time during training as well as performing We recommend this for basic sructured PCNL training for the urologist without radiation.
Limitations Needs multi center sample response assessment for construct validation Dialatation Respiratory movements To be tried in different calyceal anatomy
References 1.Chi-Fai Ng .Training in percutaneous nephrolithotomy: The learning curve and options. Arab Journal of Urology Volume 12, Issue 1, March 2014, Pages 54572.Triangulation method in PCNL https://www.youtube.com/watch?v=ZsPsrtX5bIg .Dec 18, 2012 - Uploaded by Abdelazim Hussein3.Rick C. Slater,Michael Ost . Percutaneous Stone Removal: New Approaches to Access and Imaging .Current Urology Reports. 2015; 16(5)
EVOULUTION
THANK YOU