Endoscopic Stone Treatment Step 1
The EST s1 (Endoscopic Stone Treatment step 1) is the first step of this training and assessment curriculum. Its structure offers a unique opportunity to those who want to learn the basics of endoscopy, with focus on urinary stone treatment. The EST s1 includes:
- Basic Hands-on Training (HOT) courses carried out under the guidance of experienced tutors
- A set of four dry lab exercises developed and validated by the ESU training group in collaboration with ESUT and EULIS
- EST s1 examination and certification
- An online theoretical course
Target audience : Urology residents
Aim : Improve basic endoscopic skills in the treatment of urinary stones
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
