title: Modular training for percutaneous nephrolithotripsy: The safe way to go.
abstract: Objectives should be describe a modular training scheme (MTS) which aims to provide training in percutaneous nephrolithotripsy (PCNL) and ensure the safety of the patients.
  
  
  METHODS
  Two trainees with no experience in PCNL attended the MTS under the supervision of an experienced mentor. The MTS included five modules, comprising an initial animal laboratory course (using pigs), to acquire basic skills (Module 1), and Modules 2-5 included making the puncture, tract dilatation, single-stone and large-stone management in clinical cases, respectively. Each participant progressed from one module to the next under constant mentoring and evaluation by the mentor. When the trainees completed the MTS they proceeded to perform 60 PCNL procedures independently while the mentor performed 25 for comparison purposes. A global rating scale was used for the objective evaluation of the trainees. Peri-operative variables were recorded and statistically compared as appropriate. Statistical significance was defined as P < 0.05.
  
  
  RESULTS
  One pig and 16 patients, and two pigs and 22 patients, were necessary to complete the MTS by each subject. There were no significant differences among the characteristics of the independently performed operations. The duration of surgery and fluoroscopy achieved a plateau similar to those of the mentor after ≈ 30 patients. The decrease in haemoglobin level, stone-free and complication rates in the patients were similar among the two trainees and the mentor. The complication rate of the trainees and the mentor never exceeded 13.3%.
  
  
  CONCLUSIONS
  The MTS successfully combined animal and stepwise clinical training based on a standardised technique and objective evaluation.
authors.affiliation: Department of Urology, University of Patras, Patras, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.affiliation: Department of Urology, University of Patras, Patras, Greece.
authors.forename: Iason
authors.initials: I
authors.lastname: Kyriazis
authors.affiliation: Department of Urology, University of Patras, Patras, Greece.
authors.forename: Marinos
authors.initials: M
authors.lastname: Vasilas
authors.affiliation: Department of Urology, University of Patras, Patras, Greece.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Panagopoulos
authors.affiliation: Department of Urology, University of Patras, Patras, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Georgiopoulos
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozsoy
authors.affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.affiliation: Department of Urology, University of Patras, Patras, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Liatsikos
keywords: GRS, global rating scale; MTS, modular training scheme; Modular; PCNL, percutaneous nephrolithotripsy; Percutaneous nephrolithotripsy; Renal calculi; Training