Development and evaluation of a novel cadaveric model for performance of image-guided percutaneous renal tumor ablation.
BACKGROUND
Thermal ablation is a well established treatment option for the management small renal masses. Increasingly, renal ablation is performed via a percutaneous approach. However, most urologists are not formally trained in image-based deployment of ablation needles. To address this need, we created a novel training model to teach urologists to perform precise and accurate percutaneous needle placement. This teaching model was implemented as part of a recent training course on tissue ablation organized by the American Urological Association.


METHODS
Two fresh frozen human cadavers (Anatomic Gifts Registry, Hanover, Maryland) were used in the model. Plumber's Putty (Oatey, Cleveland, Ohio) and nonpitted olives soaked in Isovue (Bracco Dianostics, Inc, New York, New York) were used to create ablation targets. Course participants underwent a tutorial on the computed tomography (CT)-guided deployment of a 19-gauge Yueh Needle (Cook Medical, Bloomington, Indiana) or Cool-tip radio-frequency ablation (RFA) probe (Covidien, Inc, Boulder, Colorado). After each needle placement, a CT scan was performed to assess successful deployment. Participants were then queried regarding their experience.


RESULTS
A total of 18 urologists performed needle or radio-frequency ablation probe placement on 2 cadavers. A mean of 3.39 (range 2-5) attempts was required to hit targets. Subjectively, participants noted an increase in confidence performing percutaneous needle deployment. The cadaver laboratory exposed participants to pretreatment planning, tactile feel of needle placement, needle readjustment, and 3-D spatial relationships of a percutaneous approach.


CONCLUSIONS
The presented cadaveric model is an effective tool for teaching percutaneous needle placement. All urologists evaluated noted increased confidence in this technique after training on the model.
Division of Endourology, Laparoscopy, and Minimally-Invasive Surgery, Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Scott M
SM
Castle
Vladislav
V
Gorbatiy
Nelson
N
Salas
Michael A
MA
Gorin
Jaime
J
Landman
Raymond J
RJ
Leveillee
D055011:Ablation Techniques / Q000193:education* / Q000295:instrumentation; D002102:Cadaver; D017115:Catheter Ablation; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D009339:Needles; D014057:Tomography, X-Ray Computed