1. Surgical Force: Initial Study and Clinical Implications in the Assessment of Ureteral Access Sheath Induced Injury.
- Author
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Lavasani, Seyed Amiryaghoub M., Rojhani, Allen, Cumpanas, Andrei D., Osann, Kathryn, Morgan, Kalon L., Hernandez, Mariah C., McCormac, Amanda, Piedras, Paul, Vo, Kelvin, Gorgen, Antonio R. H., Sharifi, Seyed Hossein H., Gao, Bruce M., Tano, Zachary E., Patel, Roshan M., Landman, Jaime, and Clayman, Ralph V.
- Subjects
MALE models ,WOUNDS & injuries ,CHI-squared test ,LOGISTIC regression analysis ,UROLOGISTS - Abstract
Purpose: Ureteral access sheaths (UAS) pose the risk of severe ureteral injury. Our prior studies revealed forces ≤6 Newtons (N) prevent ureteral injury. Accordingly, we sought to define the force urologists and residents in training typically use when placing a UAS. Materials and Methods: Among urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12F, 14F, and 16F UAS into a male genitourinary model containing a concealed force sensor; they also provided demographic information. Analysis was completed using t-tests and Chi-square tests to identify group differences when passing a 16F sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored through polychotomous logistic regression. Results: Participant force distributions were as follows: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4N and 6N; results for >8N relative to 4N and 8N were similar. Compared to high-volume ureteroscopists (those performing >20 ureteroscopies/month), physicians performing ≤20 ureteroscopies/month were significantly less likely to exert forces ≤4N (p = 0.017 and p = 0.041). Of those surpassing 6N and 8N, 15% and 18%, respectively, were high-volume ureteroscopists. Conclusions: Despite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16F access sheaths within the ideal range of 4N to 6N (74% of participants) or within a predefined safe range of 4N to 8N (61% of participants). [ABSTRACT FROM AUTHOR]
- Published
- 2024
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