Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study.

Autor: Zhang Z; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Anaesthesiology, Chongqing General Hospital, Chongqing, China., Lampotang S; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.; Office of Educational Affairs/Office of Medical Education, University of Florida College of Medicine, Gainesville, FL, USA.; Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA., Yu Y; Department of Biostatistics, University of Florida, Gainesville, FL, USA., Acar YA; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Wakim J; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA., Mei V; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA., Ahmad AE; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada., Shenot P; Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA., Lee J; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada., Perlis N; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada., Moy L; Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA., Johnson WT; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA., DeStephens A; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.; Office of Educational Affairs/Office of Medical Education, University of Florida College of Medicine, Gainesville, FL, USA., Bigos AK; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA., Lizdas DE; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA., Stringer T; Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA.; Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2021 Nov; Vol. 128 (5), pp. 615-624. Date of Electronic Publication: 2021 Jun 22.
DOI: 10.1111/bju.15445
Abstrakt: Objectives: To develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side-fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false-negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer.
Participants and Methods: Using a PBx simulator with real-time three-dimensional visualization, we devised a freehand, pitch-neutral (0°, horizontal plane), side-fire, transrectal ultrasonography (TRUS)-guided sPBx technique in the left lateral decubitus position. Thirty-four trainees on four Canadian and US urology programmes learned the technique on the same simulator, which recorded deviation from the intended template location in a double-sextant template as well as the TRUS probe pitch at the time of sampling. We defined deviation as the shortest distance in millimeters between a core centre and its intended template location, template deviation as the mean of all deviations in a template, and mastery as achieving a template deviation ≤5.0 mm.
Results: All results are reported as mean ± sd. The mean absolute pitch and template deviation before learning the technique (baseline) were 8.2 ± 4.1° and 8.0 ± 2.7 mm, respectively, and after mastering the technique decreased to 4.5 ± 2.7° (P = 0.001) and 4.5 ± 0.6 mm (P < 0.001). Template deviation was related to mean absolute pitch (P < 0.001) and increased by 0.5 mm on average with each 1° increase in mean absolute pitch. Participants achieved mastery after practising 3.9 ± 2.9 double-sextant sets. There was no difference in time to perform a double-sextant set at baseline (277 ± 102 s) and mastery (283 ± 101 s; P = 0.39).
Conclusion: A pitch-neutral side-fire technique reduced template deviation during simulated freehand TRUS-guided sPBx, suggesting it may also reduce PBx false-negatives in patients in a future clinical trial. This pitch-neutral technique can be taught and learned; the University of Florida has been teaching it to all Urology residents for the last 2 years.
(© 2021 The Authors BJU International © 2021 BJU International.)
Databáze: MEDLINE
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