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- Title:
The relationship between the force applied and perceived by the surgeon during ureteral access sheath placement: ex-vivo experimental model.
- Document type:
- Journal Article
- Author(s):
- Tefik, Tzevat; Ergül, Rifat Burak; Osther, Palle; Giusti, Guido; Preminger, Glenn M; Straub, Michael; Rassweiler, Jens Jochen; Montanari, Emanuele; Brehmer, Marianne; Seitz, Christian; Grasso, Michael; Pearle, Margaret; Proietti, Silvia; Cloutier, Jonathan; Gunver, MGuven; Nane, Ismet; Ozcan, Faruk; Traxer, Olivier
- Abstract:
- PURPOSE: To define a peak force of insertion (PFOI) threshold for ureteral damage during ureteral access sheath (UAS) placement on an experimental ureteral orifice model. METHODS: A specially designed water tank using 2 laparoscopic 5 mm ports and 2 different size (10 Fr and 8 Fr) sealing cap adaptors (SCA) as ureteral orifices was used to perform the test. A 10-12 Fr UAS was fixed to a load cell and the force of insertion (FOI) was continuously recorded with a digital force gauge.13 experts in the field of endourology who participated performed 3 UAS insertions. The FOI was recorded initially with 10 Fr followed by 8 Fr SCA. On the final insertion, the orifice was obstructed, leaving a 5 cm length to insert the UAS. The experts were asked to "Stop at the point they anticipate ureteral damage, and they would not proceed in real life". RESULTS: Using 10 Fr SCA the PFOI was 2.12 ± 0.58 Newton (N) (range:1.48-3.48) while 8 Fr SCA showed a PFOI 5.76 ± 0.96 N (range:4.05-7.35). Six of the experts, said they would stop proceeding when they reached above 5.1 N. Three experts had PFOI < 5.1 N and the other 4 stated they would go with PFOIs of 5.88, 6.16, 6.69 and 7.35 N when using SCA of 8 Fr.The highest load they would stop proceeding had a PFOI of 6.09 ± 1.87 N (range: 2.53-10.74). CONCLUSION: The PFOI threshold for ureteral damage inserting UAS of the experts is variable. Although FOI is a subjective perception, experience suggests that ureteral injury may occur at an average of 6.05 N perceived by surgeons' tactile feedback. In-vivo measurement of UAS PFOI may confirm a threshold.
- Journal title abbreviation:
- World J Urol
- Year:
- 2024
- Journal volume:
- 42
- Journal issue:
- 1
- Fulltext / DOI:
- doi:10.1007/s00345-024-04982-7
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/38753120
- Print-ISSN:
- 0724-4983
- TUM Institution:
- Klinik und Poliklinik für Urologie (Prof. Gschwend)
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