Urologic training does not impact ability to accurately size kidney stone fragments

Area of Science:

• Urology
• Surgical Technology
• Medical Education

Background:

• Accurate estimation of ureteral stone fragment size is crucial for safe extraction during ureteroscopy.
• Current methods rely on subjective visual estimation, which may be prone to error.
• The impact of surgical experience on the accuracy of fragment size estimation is not well-defined.

Purpose of the Study:

• To evaluate the accuracy of ureteral stone fragment size estimation by urology trainees and experienced surgeons.
• To determine if surgical experience or technical skill influences the accuracy of size estimation and extractability prediction.
• To assess the discrepancy between estimated and actual stone fragment sizes and its correlation with extractability.

Main Methods:

• Six mock stones (1.2-7.4 mm) were used in a simulated flexible ureteroscopy model.
• Urology residents (PGY 1-2, PGY 3-5) and high-volume ureteroscopy surgeons estimated fragment size and extractability through a 12/14-French sheath.
• Data were analyzed using ANOVA and Pearson correlation to compare accuracy across training levels and correlate with experience/skill.

Main Results:

• Participants underestimated stone fragment size by an average of 30%.
• Estimation errors increased proportionally with larger stone fragment sizes.
• No statistically significant difference in estimation accuracy or extractability prediction was found among training groups, experience levels, or technical skill.

Conclusions:

• Both novice and experienced surgeons significantly underestimate ureteral stone fragment size during ureteroscopy.
• This consistent underestimation poses a risk for unsafe stone extraction.
• Real-time measurement technologies could enhance accuracy, irrespective of surgeon experience.