Grand Prize Winner
Jasneet S. Bhullar, MD, MS, FICS(J), Junior ICS Fellow, General Surgery Resident, Department of Surgery, Providence Hospital & Medical Centers, Southfield, MI
Kidney Access Device (KAD): A New Concept and Invention
ABSTRACT
Introduction:
Percutaneous nephrolithotomy (PCNL) is the most complicated stone surgery technique to learn.
The steep learning curve is mainly related to obtaining the precise renal access by puncturing the
targeted calyx. A minimally misaligned puncture may lead to torrential bleeding, failure of the
surgery and complications. Renal puncture can take a long time and the increased fluoroscopic
time is a hazard for the patient and surgeon.
Methods:
We designed- Kidney Access Device (KAD), which helps to align the 3-dimensional targeted
calyx under fluoroscopy for precise needle placement. KAD allows access to calyces at all
angles. A 3-step puncture technique was formulated for puncturing the kidney using KAD in a
porcine model (comparable renal size and anatomy with humans). KAD was used to puncture 3
targeted calyces of bilateral kidneys in 4 pigs. Guide wires were inserted into renal collecting
system through the placed needle.
Results:
Mean time per puncture was 4±2 minutes (n=24). Necropsy showed no retroperitoneal
hematoma, visceral organ injury, or active bleeding from kidneys in any of the pigs. Kidneys
were dissected and precise intrarenal placements of guidewires in relation to targeted calyces
were noted in all 24 sites.
Conclusions:
KAD with the 3-step technique aids in the safe and accurate renal puncture even in novice hands
while drastically reducing the operative and fluoroscopy time. KAD may also be used to access
other organs and has potential applications in minimally invasive surgery.
Honorable Mention
Jonathan Egle, MD, General Surgery Resident, Providence Hospital and Medical Centers, Southfield, MI
Short-Term Surgical Missions: A Cost-Benefit Analysis
ABSTRACT
Purpose:
The global burden of surgical disease is significant and historically has been
given less attention than medical diseases. However, recently surgical treatment has been
shown in several investigations to be a cost-effective tool at established hospitals within
resource-poor nations, bringing more attention to surgical diseases world-wide. Another
method of providing general surgical care in developing countries is short-term mission
trips, but no studies have examined their cost-effectiveness. This study aims to determine
the cost-effectiveness of a recurring short-term surgical mission trip to the Dominican
Republic.
Methods:
Consecutive trips by the Midwest Medical Missions group to the Dominican
Republic were studied in 2010 and 2012. All costs pertaining to the trips were recorded,
and operative logs were maintained. Estimated costs of identical procedures carried out
at the authors' host institution were obtained. Direct comparisons were made between
the cost of similar surgeries performed in the USA and the estimated amount of money
spent on the mission trips attributable to each procedure. DALY s-averted were
calculated for both trips.
Results:
The cost for all cases performed in 2010 would have been $255,187 if
performed at the United States hospital and $398,177 in 2012. The amount actually spent
on the trips was $61,924 in 2010, and $82,368 in 2012, representing a relative costreduction
of 79%. A total of 218 DALY s were averted. An average of 3.2 DALY s were
averted per patient, and the cost per DALY averted was $662.96.
Conclusions:
Even with liberal calculations of costs, the procedures on a surgical
mission trip to the Dominican Republic were less expensive than similar care provided in
the United States. The cost per DALY averted is substantially less than the gross
domestic product per capita, demonstrating the cost-effectiveness of the trips. This is
consistent with literature supporting cost-effectiveness of surgery at established hospitals
in developing countries and subspecialty surgical mission trips to developing countries.