title: Adopting Ultrasound Guidance for Prone Percutaneous Nephrolithotomy: Evaluating the Learning Curve for the Experienced Surgeon.
abstract: To define the learning curve associated with adopting ultrasound guidance for prone percutaneous nephrolithotomy (PCNL) for the experienced surgeon.
  
  
  
  A prospective cohort study of consecutive patients undergoing PCNL with ultrasound guidance for renal tract access and dilation was performed. Clinical data reviewed included success in gaining renal access with ultrasound guidance, total fluoroscopic screening time, and radiation exposure dose. PCNL cases performed with fluoroscopic guidance matched for stone size served as control cases.
  
  
  
  One hundred consecutive ultrasound-guided procedures performed by a single experienced endourologist were divided into five experience groups. Significant improvement in renal access success rate with ultrasound was seen after 20 cases (p < 0.05). Total fluoroscopic screening time, radiation exposure dose, and operative time were also statistically significantly improved over the study period. When compared with fluoroscopy-guided PCNL, significant decreases in total fluoroscopic screening time (33.4 ± 35.3 seconds vs 157.5 ± 84.9 seconds, p < 0.05) and radiation exposure (7.0 ± 8.7 mGy vs 47.8 ± 45.9 mGy, p < 0.05) were seen. No differences in complication rates were found.
  
  
  
  Ultrasound-guided renal access for PCNL can be performed effectively after 20 cases. Transition to the use of ultrasound will quickly reduce radiation exposure for patients and intraoperative personnel.
authors.affiliation: 1 Department of Urology, University of California , San Francisco, San Francisco, California.|2 Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Chulalongkorn University , Bangkok, Thailand .
authors.forename: Manint
authors.initials: M
authors.lastname: Usawachintachit
authors.affiliation: 1 Department of Urology, University of California , San Francisco, San Francisco, California.
authors.forename: Selma
authors.initials: S
authors.lastname: Masic
authors.affiliation: 3 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California.
authors.forename: Isabel E
authors.initials: IE
authors.lastname: Allen
authors.affiliation: 4 Department of Urology, Tsinghua Changgung Hospital , Beijing, China .
authors.forename: Jianxing
authors.initials: J
authors.lastname: Li
authors.affiliation: 1 Department of Urology, University of California , San Francisco, San Francisco, California.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007669:Kidney Calculi / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D016684:Prone Position; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*