MicroBox White light PCNL puncture trainer
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 11
Abstract
Aim : To create simplest PCNL puncture trainer & understand principles of puncture PCNL Methods /Design: Two Transparent plastic boxes reformed to upper deck made of lids 3 cms apart & lower deck with bottoms glued 3cms apart with side slit. Keyboard flash LED light is moved through slit in lower deck with change in position varying 0-200 craniocaudal as well as lateromedial. Lids are hollowed like a window frame. White paper& transparent polythene sheet is taultly fixed by closing upper& lower lids which are adhered.PCS is made of clear straw with ends closed with opsite The light facing upwards below the straw in alignment gives 0o as light moves out the angulation increase to 20 0& similarly when light source is moved caudally (towards bladder ).Puncture is done with modified spinal needle. Transparent Polythene sheet gives haptic feed back & stabilise the needle in position during puncture. White paper capture shadow & is seen directly for image interpretation & puncture . Principles of Triangulation Method is use for puncture simulating prone PCNL . Observations : 1.Calyx orientation is identified by rotation 0- 200 either craniocaudal or mediolateral .When tip of calyx moves away opposite to the direction of light source the calyx is downward facing and When tip of calyx moves along the same direction of light source the calyx is upward facing 2.Superficial or deep : On 0 -200 Mediolateral Rotation When needle is fairly below calyx (deep) the gap between needle tip & calyx tip widens apart & needle shortens moving laterally immediately opposite to the direction of light (within few degrees). When needle is fairly above (superficial )the calyx the gap between the needle tip & calyx tip shortens immediately& needle overshoots calyx (appears to move towards pelvis in the same direction of light ). When calyx is punctured properly both 0 & 20o images are congruent with needle inside. On caudal 10o rotation (towards bladder), needle turns cephalad wrt calyx long axis (opposite direction of light ) when it is deeper to calyx &caudal if superficial (same direction of light ). 3.A medial drift of calyx & displacement of PCS due to calyx indentation of puncturing needle aid in accuracy of puncture . Results: The calyx filled with Ultravist contrast &sealed to obtain images under c arm. ImageJ analysis with same fixed reference points in ROI in both systems showed 97.3% SD 0.7 (n = 20) matching after adjusting magnifgication. Conclusion : This inexpensive, simple,portable model with reasonable haptics can be used for dry lab training for PCNL puncture.
Authors and Affiliations
Shankar Ram HS, Dr Aby Madan, Dr Nazar M
Keywords
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- EP ID EP244947
- DOI 10.9790/0853-1611099099
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