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 Dragos, Osann, Kathryn, Morgan, Kalon, Hernandez, Mariah C, McCormac, Amanda, Piedras, Paul, Vo, Kelvin, Gorgen, Antonio RH, Sharifi, Seyed Hossein Hosseini, Gao, Bruce, Tano, Zachary Edward, Patel, Roshan M, Landman, Jaime, and Clayman, Ralph
- Subjects
Medical Biotechnology ,Biomedical and Clinical Sciences ,Clinical Research ,Urologic Diseases ,Clinical Sciences ,Urology & Nephrology ,Clinical sciences - Abstract
PurposeUreteral 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 & methodsAmong urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12Fr, 14Fr, and 16Fr ureteral access sheaths 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 16Fr sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored via polychotomous logistic regression.ResultsParticipant force distributions were: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4-6N; results for >8N relative to 4N-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.ConclusionsDespite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16Fr access sheaths within the ideal range of 4N-6N (74% of participants) or within a predefined safe range of 4N-8N (61% of participants).
- Published
- 2024