Implementation of Minimally Invasive Percutaneous Nephrolithotomy (MIP): Comparison of the Initial Learning Curve with the Later on Clinical Routine in a Tertiary Centre

Overview

Journal World J Urol

Specialty Urology

Date 2017 Jul 12

PMID 28695419

Citations 2

Authors

T Bergmann

T R W Herrmann

Th Schiller

U Zimmermann

M Burchardt

Affiliations

Soon will be listed here.

Abstract

Objective: We report on the comparison of clinical results of the early phase of implementation of minimally invasive PNL (MIP) in a mentor-based approach with the later on clinical routine in a tertiary centre.

Patients And Methods: From January 2010 until January 2015 MIP was performed in 190 patients. Stone and patient characteristics were recorded in prospective manner. Perioperative complications were recorded within the Clavien-Classification. The first 120 consecutive patients undergoing MIP were evaluated and divided into three groups of 40 patients each. Mentor-based introduction of MIP was done within the first 40 patients (group A). Further patients were treated on routine clinical practice basis (group B and C). Treatment outcome was compared within the three groups.

Results: The groups did not significantly differ with regard to patient characteristics, operation time and decline in haemoglobin. In the mentor-based series mean stone size was 21.7 ± 12.6 vs. 15.6 ± 7.9 and 16.1 ± 8.4 mm in group B and C (p = 0.033). Primary stone-free rates were 65, 87.5 and 87.5% for the three groups (p = 0.015). Stone-free rate was higher in smaller and simple stones. Overall, complication rate was 41.7% including 36.7% Clavien grade I and II complications.

Conclusions: MIP can be implemented safe and effectively with mentor-based approach. MIP has a high safety profile, which allows high safety and efficacy of MIP at the time of implementation.

Citing Articles

Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy.

Doykov M, Kostov G, Doykova K Medicina (Kaunas). 2022; 58(3).

PMID: 35334598 PMC: 8952422. DOI: 10.3390/medicina58030422.

Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection.

Wang S, Yuan P, Peng E, Xia D, Xu H, Wang S Biomed Res Int. 2020; 2020:1354672.

PMID: 31998778 PMC: 6970485. DOI: 10.1155/2020/1354672.

References

Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M . Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int. 2011; 108(6):896-9. DOI: 10.1111/j.1464-410X.2010.09936.x. View

Schilling D, Gakis G, Walcher U, Stenzl A, Nagele U . The learning curve in minimally invasive percutaneous nephrolitholapaxy: a 1-year retrospective evaluation of a novice and an expert. World J Urol. 2010; 29(6):749-53. DOI: 10.1007/s00345-010-0553-3. View

Giusti G, Piccinelli A, Taverna G, Benetti A, Pasini L, Corinti M . Miniperc? No, thank you!. Eur Urol. 2006; 51(3):810-4. DOI: 10.1016/j.eururo.2006.07.047. View

Abdelhafez M, Amend B, Bedke J, Kruck S, Nagele U, Stenzl A . Minimally invasive percutaneous nephrolithotomy: a comparative study of the management of small and large renal stones. Urology. 2013; 81(2):241-5. DOI: 10.1016/j.urology.2012.09.030. View

Cheng F, Yu W, Zhang X, Yang S, Xia Y, Ruan Y . Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol. 2010; 24(10):1579-82. DOI: 10.1089/end.2009.0581. View

Lahme S, Bichler K, Strohmaier W, Gotz T . Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol. 2002; 40(6):619-24. DOI: 10.1159/000049847. View

FERNSTROM I, Johansson B . Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976; 10(3):257-9. DOI: 10.1080/21681805.1976.11882084. View

Abdelhafez M, Bedke J, Amend B, ElGanainy E, Aboulella H, Elakkad M . Minimally invasive percutaneous nephrolitholapaxy (PCNL) as an effective and safe procedure for large renal stones. BJU Int. 2012; 110(11 Pt C):E1022-6. DOI: 10.1111/j.1464-410X.2012.11191.x. View

Michel M, Trojan L, Rassweiler J . Complications in percutaneous nephrolithotomy. Eur Urol. 2006; 51(4):899-906. DOI: 10.1016/j.eururo.2006.10.020. View

10.

Opondo D, Tefekli A, Esen T, Labate G, Sangam K, Lisa A . Impact of case volumes on the outcomes of percutaneous nephrolithotomy. Eur Urol. 2012; 62(6):1181-7. DOI: 10.1016/j.eururo.2012.03.010. View

11.

Lahme S, Zimmermanns V, Hochmuth A, Janitzki V . [Minimally invasive PCNL (mini-perc). Alternative treatment modality or replacement of conventional PCNL?]. Urologe A. 2008; 47(5):563-8. DOI: 10.1007/s00120-008-1708-3. View

12.

Tefekli A, Karadag M, Tepeler K, Sari E, Berberoglu Y, Baykal M . Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol. 2007; 53(1):184-90. DOI: 10.1016/j.eururo.2007.06.049. View

13.

Abdelhafez M, Wendt-Nordahl G, Kruck S, Mager R, Stenzl A, Knoll T . Minimally invasive versus conventional large-bore percutaneous nephrolithotomy in the treatment of large-sized renal calculi: Surgeon's preference?. Scand J Urol. 2016; 50(3):212-5. DOI: 10.3109/21681805.2016.1155078. View

14.

Nagele U, Schilling D, Anastasiadis A, Walcher U, Sievert K, Merseburger A . [Minimally invasive percutaneous nephrolitholapaxy (MIP)]. Urologe A. 2008; 47(9):1066, 1068-73. DOI: 10.1007/s00120-008-1814-2. View

15.

de la Rosette J, P Laguna M, Rassweiler J, Conort P . Training in percutaneous nephrolithotomy--a critical review. Eur Urol. 2008; 54(5):994-1001. DOI: 10.1016/j.eururo.2008.03.052. View

16.

Nagele U, Knoll T, Schilling D, Michel M, Stenzl A . [Lower pole calyceal stones]. Urologe A. 2008; 47(7):875-84. DOI: 10.1007/s00120-008-1780-8. View

17.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

18.

Nagele U, Schilling D, Sievert K, Stenzl A, Kuczyk M . Management of lower-pole stones of 0.8 to 1.5 cm maximal diameter by the minimally invasive percutaneous approach. J Endourol. 2008; 22(9):1851-3. DOI: 10.1089/end.2008.9791. View

19.

Ziaee S, Sichani M, Kashi A, Samzadeh M . Evaluation of the learning curve for percutaneous nephrolithotomy. Urol J. 2010; 7(4):226-31. View

20.

Fuller A, Razvi H, Denstedt J, Nott L, Pearle M, Cauda F . The CROES percutaneous nephrolithotomy global study: the influence of body mass index on outcome. J Urol. 2012; 188(1):138-44. DOI: 10.1016/j.juro.2012.03.013. View