Should surgeons control fluoroscopy during urology procedures?

Jeremy Setterfield, James Watterson, Mathew Playfair, Luke T. Lavallée, Matthew Roberts, Brian Blew, J. Stuart Oake

Abstract


Introduction: Our study explored the impact of switching from surgeon- to radiation technologist (RT)-controlled fluoroscopy on fluoroscopy and operative times. We also identified factors impacting fluoroscopy and operative times for ureteroscopy (URS) with laser lithotripsy.

Methods: Patients undergoing urological procedures requiring fluoroscopy six months before and after the change from surgeonto RT-controlled fluoroscopy were identified. Median fluoroscopy and operative times were compared between cohorts. Subgroup analyses were performed based on procedure performed. A multivariate analysis identified factors associated with increased fluoroscopy and operative times for URS with laser lithotripsy.

Results: Overall, no difference was found between surgeon and RT cohorts for fluoroscopy (58.0 vs. 56.7 seconds; p=0.34) or operative times (39 vs. 36 minutes; p=0.14). For URS with laser
lithotripsy, fluoroscopy and operative times were longer in the surgeon-controlled cohort (76.0 vs. 54.0 seconds; p<0.01 and 48 vs. 40 minutes; p<0.01, respectively). For URS only, fluoroscopy time was decreased in the surgeon-controlled cohort (47.0 vs. 73.0 seconds; p=0.01). For URS with laser lithotripsy, factors independently associated with increased fluoroscopy time were male sex, flexible URS, glidewire use, and difficult ureteric stent insertion (p<0.05). Flexible ureteroscopy, glidewire use, previous ureteric stent placement, and difficult ureteric stent insertion were independently associated with increased operative time (p<0.05).

Conclusions: Fluoroscopy and operative times are not significantly influenced by who controls fluoroscopy during urologic procedures. Patients undergoing URS with laser lithotripsy have decreased
fluoroscopy and operative times with RT-controlled fluoroscopy. Patients undergoing URS only have decreased fluoroscopy times with surgeon-controlled fluoroscopy.


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DOI: http://dx.doi.org/10.5489/cuaj.3895