Volume 128, Issue 5 p. 615-624
Original Article

Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study

Zhou Zhang

Zhou Zhang

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Anaesthesiology, Chongqing General Hospital, Chongqing, China

Search for more papers by this author
Samsun Lampotang

Corresponding Author

Samsun Lampotang

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Office of Educational Affairs/Office of Medical Education, University of Florida College of Medicine, Gainesville, FL, USA

Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA

Correspondence: Samsun Lampotang, Joachim S. Gravenstein Professor of Anesthesiology and Director, Department of Anesthesiology, Center for Safety, Simulation and Advanced Learning Technologies (CSSALT), University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, USA.

e-mail: [email protected]

Search for more papers by this author
Yichao Yu

Yichao Yu

Department of Biostatistics, University of Florida, Gainesville, FL, USA

Search for more papers by this author
Yahya A. Acar

Yahya A. Acar

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey

Search for more papers by this author
Jonathan Wakim

Jonathan Wakim

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
Vincent Mei

Vincent Mei

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
Ardalan E. Ahmad

Ardalan E. Ahmad

Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada

Search for more papers by this author
Patrick Shenot

Patrick Shenot

Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA

Search for more papers by this author
Jason Lee

Jason Lee

Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada

Search for more papers by this author
Nathan Perlis

Nathan Perlis

Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada

Search for more papers by this author
Louis Moy

Louis Moy

Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
William T. Johnson

William T. Johnson

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
Anthony DeStephens

Anthony DeStephens

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Office of Educational Affairs/Office of Medical Education, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
Andre K. Bigos

Andre K. Bigos

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
David E. Lizdas

David E. Lizdas

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
Thomas Stringer

Thomas Stringer

Centre for Safety, Simulation and Advanced Learning Technologies, University of Florida College of Medicine, Gainesville, FL, USA

Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA

Search for more papers by this author
First published: 07 May 2021
Citations: 2

Z.Z. and S.L. are joint first authors.

Abstract

Objectives

To develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side-fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false-negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer.

Participants and Methods

Using a PBx simulator with real-time three-dimensional visualization, we devised a freehand, pitch-neutral (0°, horizontal plane), side-fire, transrectal ultrasonography (TRUS)-guided sPBx technique in the left lateral decubitus position. Thirty-four trainees on four Canadian and US urology programmes learned the technique on the same simulator, which recorded deviation from the intended template location in a double-sextant template as well as the TRUS probe pitch at the time of sampling. We defined deviation as the shortest distance in millimeters between a core centre and its intended template location, template deviation as the mean of all deviations in a template, and mastery as achieving a template deviation ≤5.0 mm.

Results

All results are reported as mean ± sd. The mean absolute pitch and template deviation before learning the technique (baseline) were 8.2 ± 4.1° and 8.0 ± 2.7 mm, respectively, and after mastering the technique decreased to 4.5 ± 2.7° (P = 0.001) and 4.5 ± 0.6 mm (P < 0.001). Template deviation was related to mean absolute pitch (P < 0.001) and increased by 0.5 mm on average with each 1° increase in mean absolute pitch. Participants achieved mastery after practising 3.9 ± 2.9 double-sextant sets. There was no difference in time to perform a double-sextant set at baseline (277 ± 102 s) and mastery (283 ± 101 s; P = 0.39).

Conclusion

A pitch-neutral side-fire technique reduced template deviation during simulated freehand TRUS-guided sPBx, suggesting it may also reduce PBx false-negatives in patients in a future clinical trial. This pitch-neutral technique can be taught and learned; the University of Florida has been teaching it to all Urology residents for the last 2 years.

Disclosure of Interest

None declared.