[3] Incorporation of the fluoroless C-Arm Trainer at the American Urological Association hands-on training of percutaneous renal access: Pilot study

Objective To assess the usefulness of incorporating the C-Arm Trainer (CAT) simulator into the annual American Urological Association (AUA) hands-on course for training of the percutaneous nephrolithotomy (PCNL) procedure. Methods This prospective study was conducted during the annual meeting of the AUA in 2017. The course included four stations for training the ‘bull’s eye’ technique for obtaining fluoroscopic-guided percutaneous renal access (PCA) using the CAT. After a didactic session, all participants were asked to complete a short questionnaire and undergo a pre-test to obtain a PCA in the posterior middle calyx. This was followed by 30-min practice on the simulator prior to undergoing a post-test. All participants were assessed during the pre-test and the post-test using a four-item checklist. Furthermore, all participants were asked to complete a qualitative analysis self-assessment questionnaire after the pre- and the post-test. Immediately after the course, all participants were invited to complete a course evaluation questionnaire. At 2 months after the course, all participants were asked to respond to a post-course survey to assess the usefulness and clinical impact of the course. Results A total of 38 physicians, who attended the hands-on course, voluntarily participated in the study. Most of them were attending urologists (79%), with a mean of 9-years of independent practice. Only 21.1% had previous practice on PCNL simulators. Compared with the pre-test, there was significant improvement in the checklist total score ( P P  = 0.003), situational stress ( P  = 0.003), and performance ( P = 0.003 ) during the post-test. The participants considered the CAT very useful for training in PCA (score 5.3/6). A total of 14 (36%) participants responded to the course evaluation questionnaire, seven (50%) evaluated the course as excellent, four (28.6%) as very good, and three (21.4%) as good. Conclusion The CAT simulator was considered useful for training in PCA. There was significant improvement in the qualitative and quantitative parameters during the post-test compared with the pre-test.