AUA 2018: Crowdsourcing: Ureteroscopy

San Francisco, CA ( Dr. Khurshid Ghani began the plenary session with an innovative type of presentation that has not been utilized in previous years. To begin, he asked the audience to download an app used for crowdsourcing so that live voting could be presented at the meeting. Throughout the half hour session, three ureteroscopic videos of stone fragmentation and stone removal were shown to the audience. Then, respect for tissue, time and motion, and instrument handling were asked to be graded from 0 to 5 (5 being excellent). The current audiences scores would then be compared to AUA members who answered the survey prior to the AUA conference using the Crowd-Sourced Assessment of Technical Skills (C-SATS) platform. A video was shown during the transition from one speaker to the next, with a total of three different videos shown. After the first video was shown and voted upon, the first presenter came to the podium. 

The first speaker, Dr. Oliver Traxer from the University Pierre et Marie Curie in Paris, used his time during this session to discuss the importance of the laser fiber during laser lithotripsy and additional tips for efficient stone fragmentation. One of the main points that Dr. Traxer explained was the crucial difference between Stripped or Unstripped laser fiber tips. He explained that the stripped laser fiber still used a transparent tip that he strongly recommended against during ureteroscopic lithotripsy. Dr. Traxer argued that the surgeon does not receive as much visibility with the transparent tip as opposed to a blue colored tip which therefore results in decreased control during stone fragmentation. Additionally, the transparent tip, if broken and lodged into the surrounding tissue, was very difficult to remove as compared to the more pliable unstripped tip. To close, he recommended that the surgeon simply cut the stripped transparent tip before beginning ureteroscopy. 

After another ureteroscopic video for the audience to judge, the next speaker, Dr. Robert Sweet from the University of Washington, took to the stage. Dr. Sweet focused his presentation on advanced ureteroscopic basketing techniques, or “tricks” as he referred it, to improve stone free rates. One such method he described was the “Frog” technique for multiple smaller fragment collection. For small stones that are around a corner within a papilla that you may not be able to reach, Dr. Sweet recommended that the surgeon use a blast of irrigation to readjust the position of the stone, then quickly close the basket on the stone, such as a frog catching a fly. He later introduced an intuitive technique referred to as the “Cowboy” technique for stones stuck on the papilla. By opening the basket and using it as a lasso by bending the basket on the papilla, the surgeon is able to scoop under the stone and pluck it off of the papilla without additional damage to the renal anatomy. 

In closing, Dr. Ghani readdressed the crowd to speak on his novel presentation utilizing crowd sourcing of ureteroscopic videos at different levels of expertise. Interestingly, for all three ureteroscopy videos, the expert cohort (n=3) AUA member crowd (n=300), and C-SATS lay crowd (n=300), there was full agreement on the rank of each video based on performance (Video B > Video A > Video C). Though the rank matched between the three cohorts, the crowd was very tightly organized with little variation between the three videos, even though the rank was correct. This shows a hopeful future for the increased use of C-SATS to rank surgical skill in a clinical setting. 

Presented by: Robert Sweet, University of Washington, Oliver Traxer, University Pierre et Marie Curie Paris
Moderator -  Khurshid Ghani, University of Michigan

Written by Zachary Valley, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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