Endoscopic Stone Treatment - Step 1 (ESTs1)
This Basic Endoscopic Stone Treatment training is the first step in the Endoscopic Stone Treatment (EST) curriculum. It is designed to provide urologists with a fundamental understanding of endoscopic stone treatment and enhance their skills. This comprehensive training is specifically tailored for urologists who want to gain a basic level of knowledge in endoscopy and wish to improve their proficiency in key techniques for endoscopic stone management. The curriculum includes four key exercises that provide hands-on experience and practical training: Flexible Cystoscopy, Rigid Cystoscopy, Semi-Rigid Ureteroscopy, and Flexible Ureteroscopy.
Training aim
The primary objective of this programme is to enhance participants’ skills in the treatment of urinary stones with endoscopic techniques. By the end of the course, attendees should feel more confident and competent in their basic skills.
- Hands-on Training.
- Semi-live surgery sessions.
- Operating area setup and organization.
- The management of equipment
- Standardized technical approach of a urological procedure.
- Surgical strategy and benchmarks for certain urological indications.
- Management of critical details related to an urological procedure.
Exercises
Flexible cystoscopy
Task:
Enter the bladder and touch three of the marks, as indicated by the tutor
Guidewire has to be pre-loaded in the cystoscope
Guidewire has to be moved in/out to touch each target
Marks are fundus, anterior wall, left wall, right wall
Instruments: Flexible cystoscope, guidewire (hard tip)
Error:
– Incorrect use/position of the scope handle
– Incorrect response to tutors’ navigation requests
– Advancing guidewire with bent cystoscope tip
– Moving the guidewire sideways to touch the targets (without in/out movement)
Target time: 36 seconds
Rigid cystoscopy
Task:
Assemble the cystoscope (optics, short bridge, sheath)
Enter the bladder and touch two of the four marks, as indicated by the tutor
Guidewire has to be pre-loaded in the cystoscope
Guidewire has to be moved in/out to touch each target
Cannulate the ureter with the safety guidewire
Marks are fundus, anterior wall, left wall, right wall
Instruments: Rigid Cystoscope, safety guidewire
Error:
– Incorrect assembly of the cystoscope
– Excessive force application during rigid scope insertion
– Not keeping urethral lumen central in the image during urethroscopy
– Incorrect response to tutors’ navigation requests
– Failing at cannulating the ureter with the guidewire
Target time: 41 seconds
Semi-rigid Ureteroscopy
Task:
Perform a ureteroscopy next to the safety guidewire (already in place) and with the working guidewire on tip
Guidewire has to be pre-loaded in the ureteroscope
Leave the working guidewire in place
Place the access sheath over the working guidewire
Instruments: Semi-rigid Ureteroscope, working guidewire, access sheath
Error:
– Not keeping the ureteral lumen in the center of the field of vision for the majority of time.
– Failing at leaving working guidewire in place
– Placing the access sheath/guidewire with no lubrification
– Failing at positioning access sheath safely
Target time: 67 seconds
Flexible Ureteroscopy
Task:
Enter the access sheath with the flexible ureteroscope up to the most distal calices
Visualize and enter calices from 1 to 6 (touch the wall) and move back the access sheath to next proximal section
Visualize and enter calices from 7 to 10 (touch the wall) and exit the box with scope and sheath under direct vision
Instruments: Flexible Ureteroscope, access sheath
Error:
– Rough handling of the scope
– Calices not correctly visualized
– Scope and sheath extracted not under direct vision
Target time: 206 seconds
ESTs1 Certification
To pass the initial stage of the Endoscopic Stone Treatment (EST) curriculum, you must successfully navigate through the Endoscopic Stone Treatment step 1 exam (ESTs1 exam)
