title: New ex vivo organ model for percutaneous renal surgery using a laparoendoscopic training box: the sandwich model.
abstract: OBJECTIVE
  Percutaneous renal surgery (PRS) is a challenging procedure for urologic surgeons and requires a large variety of different skills. Our objective was to improve the preexisting porcine kidney-training model for percutaneous renal access and PRS.
  
  
  METHODS
  For our biologic training model, we use porcine kidneys with preserved ureter. The ureter was dissected, stones were placed into the collecting system using a 16, 5F Amplatz sheath, and a 12Ch indwelling catheter was placed in the ureter for further irrigation with blue-dyed saline. The kidney was placed between two porcine full-thickness skin lobes in an existing laparoscopy trainer (SITUS Box). The kidney was punctured with ultrasound guidance, and minimally invasive percutaneous nephrolithotomy (MIP) was then performed as previously described. The model was evaluated in MIP training courses, which are regularly held at the Hannover Medical School.
  
  
  RESULTS
  All trainees were urologists with experience in endourologic surgery. Eleven participants were trained in this model. Percutaneous puncture under ultrasonographic guidance and following intrarenal surgery was successful in all 11 (100 %) cases. Therefore, all participants rated the model useful for simulating percutaneous renal surgery.
  
  
  CONCLUSIONS
  Compared to recently published models, this new porcine kidney model is easy to prepare and is cost-effective by using standard material. Moreover, it provides realistic and reproducible practice for PRS in the laboratory. Unfavorably, the described organ model requires an existing laparoscopy training system. Comprehensively, the presented organ model approximates the natural retroperitoneal circumstances precisely by using the two full-thickness skin flaps with the fatty subcutaneous tissue.
authors: Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors: Stephan
authors: S
authors: Jutzi
authors: Florian
authors: F
authors: Imkamp
authors: Markus A
authors: MA
authors: Kuczyk
authors: Ute
authors: U
authors: Walcher
authors: Udo
authors: U
authors: Nagele
authors: Thomas R W
authors: TR
authors: Herrmann
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004502:Education, Medical, Continuing / Q000379:methods*; D004724:Endoscopy / Q000193:education / Q000379:methods; D004867:Equipment Design; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000193:education*; D008962:Models, Theoretical; D009392:Nephrectomy / Q000193:education* / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D013552:Swine; D014572:Urology / Q000193:education*
references: Urology. 2008 Sep;72(3):513-6
references: 18639322
references: Urologe A. 2008 May;47(5):563-8
references: 18373077
references: J Endourol. 2005 Apr;19(3):279-82
references: 15865512
references: Urologe A. 2008 Sep;47(9):1066, 1068-73
references: 18709351
references: Int Braz J Urol. 2003 Mar-Apr;29(2):151-4
references: 15745500
references: J Urol. 2004 Nov;172(5 Pt 1):1950-2
references: 15540763
references: Eur Urol. 2008 Nov;54(5):994-1001
references: 18394783
references: Eur Urol. 2007 Apr;51(4):899-906; discussion 906
references: 17095141
references: Eur Urol. 2003 Dec;44(6):709-13
references: 14644124
references: J Endourol. 2010 Jul;24(7):1075-9
references: 20575685
references: J Endourol. 2007 May;21(5):545-50
references: 17523912
references: BJU Int. 2005 Oct;96(6):875-8
references: 16153221
references: J Urol. 2006 Nov;176(5):2173-8
references: 17070287
references: Int Braz J Urol. 2011 May-Jun;37(3):388-94
references: 21756387
references: Eur Urol. 2007 Jul;52(1):206-11
references: 17229522
references: Urol Res. 2005 Jun;33(3):191-3
references: 15918072
references: Urologe A. 2008 Jul;47(7):875-84
references: 18523751
references: Chin Med J (Engl). 2011 May;124(9):1286-9
references: 21740734
references: Urol Res. 2009 Apr;37(2):107-10
references: 19277625