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281 A durable, low-cost training model for percutaneous renal access

Purpose of study Obtaining access into the renal collecting system is technically challenging. Currently, interventional radiologists and urologic surgeons acquire most of their operative training during surgical cases on live patients. This training paradigm may compromise patient safety. The purpose of this study was to design and implement a low-cost training phantom model for gaining percutaneous renal access that could improve a trainee’s technical skills without compromising patient safety. Methods used A model renal collecting system was fashioned from a surgical glove filled with contrast-enhanced (30%) ballistic gelatin. The gelatin was formulated 1 part ballistic gelatin powder to 9 parts hot water by weight. The collecting system was then placed into a large container which was filled with ballistic gelatin that did not contain contrast. After the gelatin set, the finished block was placed into a model with a clear acrylic glass base, open side, and a cover of polyethylene foam. Two-centimeter-wide chalk pieces were incorporated into the cover to simulate ribs. Participants were taught to access each renal calyx with a needle under fluoroscopic guidance. Successful renal access was confirmed by direct visualisation through the side or the acrylic glass base. The primary outcomes were feasibility, cost, durability, and subjective similarity to clinical renal access. Summary of results Ballistic gelatin proved to be a durable and accurate medium for PCNL training. Each gelatin block sustained over 200 needle punctures with no observable compromise in structure. The contrast-enhanced gelatin collecting system did not leak when pierced by a needle allowing back to back trials without loss of integrity. In addition, the simulated ribs were clearly visualised on fluoroscopy and added an additional layer of complexity to renal access. The supplies required to construct four models cost approximately 300 dollars. The model was considered robust, realistic, and an effective training model for renal access. Conclusions This low-cost model was durable and effective. Use of this model could avoid skills acquisition in live patients and subsequently improve patient safety during percutaneous renal access.