These light sources produce thermal energy and improper use in the operating room has resulted in thermal injury and ignition of flammable materials.
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
e247
MP22-14
MP22-15
EVALUATION OF IGNITION AND BURN RISK ASSOCIATED WITH CONTEMPORARY FIBEROPTIC AND DISTAL SENSOR ENDOSCOPIC TECHNOLOGY
PRELIMINARY EVALUATION OF A NOVEL PCNL TRAINER
Kyle Spradling*, Brittany Uribe, Zhamshid Okhunov, Martin Hofmann, Michael del Junco, Christina Hwang, Caden Gruber, Ramy Youssef, Jaime Landman, Orange, CA INTRODUCTION AND OBJECTIVES: Contemporary endoscopic procedures utilize a variety of technologies connected to powerful light sources to provide illumination during diagnostic and therapeutic surgical procedures. These light sources produce thermal energy and improper use in the operating room has resulted in thermal injury and ignition of flammable materials. Our objective was to systematically evaluate the ignition and burn risk associated with contemporary fiberoptic and distal sensor endoscopic technologies. METHODS: We used a SCB Xenon 300 light source to illuminate a 4.8 mm fiberoptic cable, 10 mm laparoscope, 5 mm laparoscope, semi-rigid cystoscope, semi-rigid ureteroscope, flexible cystoscope, flexible ureteroscope, distal sensor cystoscope, and a distal sensor ureteroscope (Karl Storz, Inc., Tuttlingen, Germany). We measured peak temperatures at the distal end of each device using a thermocouple. We then placed each device on flat and folded surgical drapes and monitored for charring to establish the ignition risk. Finally, we positioned each device in contact with human cadaver skin covered by surgical drapes and evaluated for burn risk. RESULTS: Peak temperatures recorded for each device ranged from 23.3 C (semi-rigid cystoscope) to 194.5 C (fiberoptic cable). Peak temperatures of distal sensor cystoscopes and ureteroscopes were found to be higher than those of fiberoptic cystoscopic and ureteroscopic devices. Surgical drape ignition was noted when the fiberoptic cable was placed against a fold of drape. Contact with the fiberoptic cable, 10 mm laparoscope, 5 mm laparoscope, and distal sensor cystoscope resulted in cadaver skin damage. Thermal damage to cadaver skin occurred despite little or no visible change to the surgical drape. Semi-rigid and flexible cystoscopes and ureteroscopes had no effect on surgical drapes or skin. CONCLUSIONS: Fiberoptic light cables and some endoscopic devices have the potential to cause thermal injury and drape ignition. Patient injury may occur without visible damage to surgical drapes. Surgeons should be aware of the risks associated with these devices and take necessary safety precautions to prevent patient injury.
Ashish Rawandale*, Dhule, India; lokesh Patni, Yaser Ahmad, Pramod Patil, Dhule, India INTRODUCTION AND OBJECTIVES: PCNL has a significant learning curve. Commercial simulators have prohibitive costs/pitfalls. We constructed, evaluated and patented an indigenous PCNL simulator METHODS: Our portable fluoroscopy compatible simulator was designed using CAD (FIG 2) and fabricated. It uses the usual PCNL instruments, replicates natural tissue-haptics, has various error alarms, simulates respiratory movements and uses regular uroendoscope to confirm successful puncture Simulator evaluation (Fig 1): “Simulator orientation and puncture demonstration” was performed by PCNL expert (control). 13 trainees underwent a 3-step test in the operating room. Step 1: 3 successful punctures were performed and “End points” measured Step 2: Two practice sessions given (30mins each) Step 3: Repeat test as in step 1 Pre and post test subjective performance was assessed with GRS scale. Trainee feedback forms analysed RESULTS: Table 1 Trainees demonstrated showed a rightward shift in all the parameters. Data can help 9 quantify the individual training hours mandatory to reach the desired expertise. Subjective simulator assessment indicated a high degree of satisfaction on effectiveness of simulator CONCLUSIONS: Our PCNL simulator is an efficient means of skill acquisition. It provides an opportunity for supervised, repetitive performance of essential technical skills in a controlled, low stress, OR environment. It allows trainee evaluation, provides tailored training sessions and has the potential to decrease the learning curve for skill acquisition in order to maximise trainee performance. It has a low initial and maintenance cost. Developing such simulators may open up new avenues in urology trainee education Table 1 Objective and GRS assessments Mean Pretest parameters
Mean Postest parameters
p value
Identify anatomy
2.38
4.46
