Impact of Surgical Experience on Radiation Exposure during Retrograde Intrarenal Surgery

A Propensity-Score Matching Analysis

Luca Boeri, Andrea Gallioli, Elisa De Lorenzis, Matteo Fontana, Franco Palmisano, Gianluca Sampogna, Stefano Paolo Zanetti, Vito Lorusso, Ilaria Sabatini, Irene Fulgheri, Giorgio Malagò, Roberto Brambilla, Mauro Campoleoni, Giancarlo Albo, Fabrizio Longo, Andrea Salonia, Emanuele Montanari

Research output: Contribution to journalArticle

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Abstract

Background: The impact of surgical experience on radiation exposure (RE) during endourological procedures has been poorly investigated. Objective: To assess the impact of surgical experience on fluoroscopy time (FT) and RE during retrograde intrarenal surgery (RIRS). Design, setting, and participants: The study included 140 patients who underwent RIRS performed either by a senior surgeon (expertise of >100 RIRSs) (group A) or by two junior residents (expertise of <15 RIRSs) (group B) between January 2016 and May 2018. Outcome measurements and statistical analysis: We tested the hypothesis that surgical experience had a limited impact on RE during RIRS. To adjust for potential baseline confounders, propensity-score matching was performed. Descriptive statistics and linear regression models tested the association between clinical variables and FT and patients’ effective doses. Results and limitations: There was no significant difference between the two groups for baseline, intraoperative, and postoperative characteristics. Overall FT (p = 0.97) and effective dose (p = 0.79) did not differ between groups. A statistically significant association was found between male sex (all p < 0.03), stone burden (all p < 0.001), operative time (all p < 0.003), and postoperative double-J placement (all p < 0.02) with both FT and effective dose. Linear multivariable analysis revealed that body mass index was significantly associated with effective dose (p = 0.002). Similarly, longer operative time (all p < 0.03) and double-J placement (all p < 0.04) were significantly associated with increased FT and effective dose. Conclusions: Surgical experience has a limited impact on FT and RE during RIRS. Longer operative time and double-J placement were associated with increased FT and effective dose. Patient summary: In this study, we assessed whether surgical experience affects fluoroscopy time and patient's effective dose during retrograde intrarenal surgery (RIRS). We found that radiation exposure (RE) was not affected by surgeon's experience and that the standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing RE during RIRS. Surgical experience has a limited impact on fluoroscopy time and patient's radiation exposure during retrograde intrarenal surgery (RIRS). Standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing radiation exposure during RIRS.

Original languageEnglish
JournalEuropean Urology Focus
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Propensity Score
Fluoroscopy
Operative Time
Learning Curve
Linear Models
Radiation Exposure
Body Mass Index
Surgeons

Keywords

  • Effective dose
  • Fluoroscopy time
  • Radiation exposure
  • Retrograde intrarenal surgery
  • Surgical experience

ASJC Scopus subject areas

  • Urology

Cite this

Impact of Surgical Experience on Radiation Exposure during Retrograde Intrarenal Surgery : A Propensity-Score Matching Analysis. / Boeri, Luca; Gallioli, Andrea; De Lorenzis, Elisa; Fontana, Matteo; Palmisano, Franco; Sampogna, Gianluca; Zanetti, Stefano Paolo; Lorusso, Vito; Sabatini, Ilaria; Fulgheri, Irene; Malagò, Giorgio; Brambilla, Roberto; Campoleoni, Mauro; Albo, Giancarlo; Longo, Fabrizio; Salonia, Andrea; Montanari, Emanuele.

In: European Urology Focus, 01.01.2018.

Research output: Contribution to journalArticle

Boeri, L, Gallioli, A, De Lorenzis, E, Fontana, M, Palmisano, F, Sampogna, G, Zanetti, SP, Lorusso, V, Sabatini, I, Fulgheri, I, Malagò, G, Brambilla, R, Campoleoni, M, Albo, G, Longo, F, Salonia, A & Montanari, E 2018, 'Impact of Surgical Experience on Radiation Exposure during Retrograde Intrarenal Surgery: A Propensity-Score Matching Analysis', European Urology Focus. https://doi.org/10.1016/j.euf.2018.08.028
Boeri, Luca ; Gallioli, Andrea ; De Lorenzis, Elisa ; Fontana, Matteo ; Palmisano, Franco ; Sampogna, Gianluca ; Zanetti, Stefano Paolo ; Lorusso, Vito ; Sabatini, Ilaria ; Fulgheri, Irene ; Malagò, Giorgio ; Brambilla, Roberto ; Campoleoni, Mauro ; Albo, Giancarlo ; Longo, Fabrizio ; Salonia, Andrea ; Montanari, Emanuele. / Impact of Surgical Experience on Radiation Exposure during Retrograde Intrarenal Surgery : A Propensity-Score Matching Analysis. In: European Urology Focus. 2018.
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title = "Impact of Surgical Experience on Radiation Exposure during Retrograde Intrarenal Surgery: A Propensity-Score Matching Analysis",
abstract = "Background: The impact of surgical experience on radiation exposure (RE) during endourological procedures has been poorly investigated. Objective: To assess the impact of surgical experience on fluoroscopy time (FT) and RE during retrograde intrarenal surgery (RIRS). Design, setting, and participants: The study included 140 patients who underwent RIRS performed either by a senior surgeon (expertise of >100 RIRSs) (group A) or by two junior residents (expertise of <15 RIRSs) (group B) between January 2016 and May 2018. Outcome measurements and statistical analysis: We tested the hypothesis that surgical experience had a limited impact on RE during RIRS. To adjust for potential baseline confounders, propensity-score matching was performed. Descriptive statistics and linear regression models tested the association between clinical variables and FT and patients’ effective doses. Results and limitations: There was no significant difference between the two groups for baseline, intraoperative, and postoperative characteristics. Overall FT (p = 0.97) and effective dose (p = 0.79) did not differ between groups. A statistically significant association was found between male sex (all p < 0.03), stone burden (all p < 0.001), operative time (all p < 0.003), and postoperative double-J placement (all p < 0.02) with both FT and effective dose. Linear multivariable analysis revealed that body mass index was significantly associated with effective dose (p = 0.002). Similarly, longer operative time (all p < 0.03) and double-J placement (all p < 0.04) were significantly associated with increased FT and effective dose. Conclusions: Surgical experience has a limited impact on FT and RE during RIRS. Longer operative time and double-J placement were associated with increased FT and effective dose. Patient summary: In this study, we assessed whether surgical experience affects fluoroscopy time and patient's effective dose during retrograde intrarenal surgery (RIRS). We found that radiation exposure (RE) was not affected by surgeon's experience and that the standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing RE during RIRS. Surgical experience has a limited impact on fluoroscopy time and patient's radiation exposure during retrograde intrarenal surgery (RIRS). Standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing radiation exposure during RIRS.",
keywords = "Effective dose, Fluoroscopy time, Radiation exposure, Retrograde intrarenal surgery, Surgical experience",
author = "Luca Boeri and Andrea Gallioli and {De Lorenzis}, Elisa and Matteo Fontana and Franco Palmisano and Gianluca Sampogna and Zanetti, {Stefano Paolo} and Vito Lorusso and Ilaria Sabatini and Irene Fulgheri and Giorgio Malag{\`o} and Roberto Brambilla and Mauro Campoleoni and Giancarlo Albo and Fabrizio Longo and Andrea Salonia and Emanuele Montanari",
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TY - JOUR

T1 - Impact of Surgical Experience on Radiation Exposure during Retrograde Intrarenal Surgery

T2 - A Propensity-Score Matching Analysis

AU - Boeri, Luca

AU - Gallioli, Andrea

AU - De Lorenzis, Elisa

AU - Fontana, Matteo

AU - Palmisano, Franco

AU - Sampogna, Gianluca

AU - Zanetti, Stefano Paolo

AU - Lorusso, Vito

AU - Sabatini, Ilaria

AU - Fulgheri, Irene

AU - Malagò, Giorgio

AU - Brambilla, Roberto

AU - Campoleoni, Mauro

AU - Albo, Giancarlo

AU - Longo, Fabrizio

AU - Salonia, Andrea

AU - Montanari, Emanuele

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The impact of surgical experience on radiation exposure (RE) during endourological procedures has been poorly investigated. Objective: To assess the impact of surgical experience on fluoroscopy time (FT) and RE during retrograde intrarenal surgery (RIRS). Design, setting, and participants: The study included 140 patients who underwent RIRS performed either by a senior surgeon (expertise of >100 RIRSs) (group A) or by two junior residents (expertise of <15 RIRSs) (group B) between January 2016 and May 2018. Outcome measurements and statistical analysis: We tested the hypothesis that surgical experience had a limited impact on RE during RIRS. To adjust for potential baseline confounders, propensity-score matching was performed. Descriptive statistics and linear regression models tested the association between clinical variables and FT and patients’ effective doses. Results and limitations: There was no significant difference between the two groups for baseline, intraoperative, and postoperative characteristics. Overall FT (p = 0.97) and effective dose (p = 0.79) did not differ between groups. A statistically significant association was found between male sex (all p < 0.03), stone burden (all p < 0.001), operative time (all p < 0.003), and postoperative double-J placement (all p < 0.02) with both FT and effective dose. Linear multivariable analysis revealed that body mass index was significantly associated with effective dose (p = 0.002). Similarly, longer operative time (all p < 0.03) and double-J placement (all p < 0.04) were significantly associated with increased FT and effective dose. Conclusions: Surgical experience has a limited impact on FT and RE during RIRS. Longer operative time and double-J placement were associated with increased FT and effective dose. Patient summary: In this study, we assessed whether surgical experience affects fluoroscopy time and patient's effective dose during retrograde intrarenal surgery (RIRS). We found that radiation exposure (RE) was not affected by surgeon's experience and that the standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing RE during RIRS. Surgical experience has a limited impact on fluoroscopy time and patient's radiation exposure during retrograde intrarenal surgery (RIRS). Standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing radiation exposure during RIRS.

AB - Background: The impact of surgical experience on radiation exposure (RE) during endourological procedures has been poorly investigated. Objective: To assess the impact of surgical experience on fluoroscopy time (FT) and RE during retrograde intrarenal surgery (RIRS). Design, setting, and participants: The study included 140 patients who underwent RIRS performed either by a senior surgeon (expertise of >100 RIRSs) (group A) or by two junior residents (expertise of <15 RIRSs) (group B) between January 2016 and May 2018. Outcome measurements and statistical analysis: We tested the hypothesis that surgical experience had a limited impact on RE during RIRS. To adjust for potential baseline confounders, propensity-score matching was performed. Descriptive statistics and linear regression models tested the association between clinical variables and FT and patients’ effective doses. Results and limitations: There was no significant difference between the two groups for baseline, intraoperative, and postoperative characteristics. Overall FT (p = 0.97) and effective dose (p = 0.79) did not differ between groups. A statistically significant association was found between male sex (all p < 0.03), stone burden (all p < 0.001), operative time (all p < 0.003), and postoperative double-J placement (all p < 0.02) with both FT and effective dose. Linear multivariable analysis revealed that body mass index was significantly associated with effective dose (p = 0.002). Similarly, longer operative time (all p < 0.03) and double-J placement (all p < 0.04) were significantly associated with increased FT and effective dose. Conclusions: Surgical experience has a limited impact on FT and RE during RIRS. Longer operative time and double-J placement were associated with increased FT and effective dose. Patient summary: In this study, we assessed whether surgical experience affects fluoroscopy time and patient's effective dose during retrograde intrarenal surgery (RIRS). We found that radiation exposure (RE) was not affected by surgeon's experience and that the standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing RE during RIRS. Surgical experience has a limited impact on fluoroscopy time and patient's radiation exposure during retrograde intrarenal surgery (RIRS). Standardisation of the surgical technique at the beginning of the learning curve of young surgeons may represent the key factor in reducing radiation exposure during RIRS.

KW - Effective dose

KW - Fluoroscopy time

KW - Radiation exposure

KW - Retrograde intrarenal surgery

KW - Surgical experience

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