Impact of Fellowship Training on Surgical Efficiency in Ureteroscopic Stone Treatment: A Comparative Analysis of Fellows and Fellowship-Trained Surgeons

Abstract

Introduction As retrograde laser lithotripsy for nephrolithiasis has grown in prevalence, concerns over the associated increased intrarenal pressure (IIRP) and heat have arisen. Our study aims to show fellowship training produces more efficient surgeons with less OR time and laser energy usage, leading to increased patient safety. Materials and Methods We conducted a retrospective analysis of 1833 patients who underwent RIRS, ureteroscopy, or both with laser lithotripsy. Procedures were performed by fellows or fellowship trained surgeons. Pertinent patient, stone and operation parameters were recorded, and statistical analysis was then performed. Results Stone characteristics revealed no significant differences between cases performed by fellows and fellowship-trained surgeons. Surgical duration and total OR time were significantly higher in the fellow arm in both rigid and flexible subgroups. Fellowship training was associated with lower laser energy density (Joules/mm³ of stone) during rigid URS, but not the flexible subgroup. Discussion Multiple studies have reported the adverse effects of IIRP and intrarenal/intraureteral heat during laser lithotripsy. Our study demonstrates fellowship training results in less intraoperative time in both URS and RIRS, reducing the time renal tissue is exposed to IIRP and heat. We also demonstrated that less energy density was applied by fellowship trained endourologist during rigid URS, a marker of efficiency. These factors represent an overall benefit to patients. Conclusion The increased usage retrograde laser lithotripsy has resulted in an associated rise in intrarenal pressure and heat. Fellowship training is associated with decreased OR time and decreased laser energy density application during rigid ureteroscopy.