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A Glove Model For Learning Percutaneous Calyx Access

Introduction and objectives: many biological models with porcine kidney have been developed, to facilitate the learning and training of percutaneous renal surgery. We present a video of a model using a latex glove for percutaneous calyx puncture.
Materials and Methods: Two or three foam layers are used to simulate the abdominal wall layers. A ureteral catheter is inserted in a latex glove, which is closed using a few ligations. The glove is filled with saline solution and contrast media. It is placed on the distal-half of the foams with the fingers looking toward the middle. The fingers are fixed to the foam using medical tapes. The foams are folded, so that the glove is covered. The puncture, guidewire insertion, and small dilation are performed under fluoroscopic guidance. Urologist and residents were taught needle access, and the beginning of tract dilation.
Results: The glove model is simple to set up, with a preparation time of about a few minutes. It is economical, by using widely available material. Percutaneous puncture and limited dilation were possible, and almost realistic, in all the glove’s fingers and with the same techniques used in real percutaneous access. The needle mobilization and puncture of the glove’s fingertip are similar to the feeling of the calyx puncture. Guidewire insertion and small sequential dilation are possible. However, large dilation and Amplatz sheath insertion are difficult or impossible; the finger is pushed by the dilator. It is a non-biological model so there is a limitation in terms of “tissue feeling” and for anatomic relations. In addition, ultrasound-imaging guidance cannot be used. Evaluations submitted by training session participants revealed a high degree of satisfaction with model effectiveness in the application of percutaneous calyx puncture.
Conclusions: This glove model is an effective mean of skills acquisition especially for percutaneous calyx puncture. It provides a low stress environment that offers an opportunity for supervised, repetitive performance of this essential technical skill. However, further technical experience and comparative studies with biologic and virtual reality simulators are necessary to evaluate this technique.


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