Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study
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 authorCorresponding 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 authorYichao Yu
Department of Biostatistics, University of Florida, Gainesville, FL, USA
Search for more papers by this authorYahya 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 authorJonathan 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 authorVincent 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 authorArdalan 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 authorPatrick Shenot
Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
Search for more papers by this authorJason 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 authorNathan 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 authorLouis Moy
Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
Search for more papers by this authorWilliam 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 authorAnthony 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 authorAndre 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 authorDavid 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 authorThomas 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 authorZhou 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 authorCorresponding 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 authorYichao Yu
Department of Biostatistics, University of Florida, Gainesville, FL, USA
Search for more papers by this authorYahya 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 authorJonathan 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 authorVincent 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 authorArdalan 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 authorPatrick Shenot
Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
Search for more papers by this authorJason 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 authorNathan 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 authorLouis Moy
Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
Search for more papers by this authorWilliam 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 authorAnthony 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 authorAndre 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 authorDavid 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 authorThomas 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 authorZ.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.
Supporting Information
Filename | Description |
---|---|
bju15445-sup-0001-FigS1.docxWord document, 118.2 KB | Fig. S1. Determining neutral TRUS-guided probe pitch from the sagittal TRUS display. |
bju15445-sup-0002-FigS2.docxWord document, 168.1 KB | Fig. S2. Maintaining the prostate phantom cross-section during fine adjustment of the needle path to the intended template location using yaw along the sagittal insonation plane. |
bju15445-sup-0003-FigS3.docxWord document, 89.9 KB | Fig. S3. Relevant biopsy needle tip dimensions to help determine how far to insert the biopsy needle before firing it. |
bju15445-sup-0004-FigS4.docxWord document, 114.6 KB | Fig. S4. Mean absolute pitch predicts template deviation for 12 cores in a double-sextant template. |
bju15445-sup-0005-FigS5.docxWord document, 144.1 KB | Fig. S5. Absolute pitch predicts the deviation of the actual core from the individual template location. |
bju15445-sup-0006-Text.docxWord document, 18.6 KB | Appendix S1. Pitch-neutral technique for side-fire, TRUS sPBx on a simulator with patient in left lateral decubitus position. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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