Unfortunately, this invasive procedure is associated with increased risk for adverse, even lethal, outcomes. Simulation training has been shown to improve procedure competencies; therefore, we developed an inexpensive simulation tool for teaching and practicing real-time ultrasound-guided percutaneous renal biopsy. This model mimics human kidney biopsy conditions in terms of kidney size, depth, tissue echogenicity, and overall structural characteristics. The preparation is simple, consisting of inserting a porcine kidney phantom under a turkey breast, using standard ultrasound imaging and semiautomatic needles,

and allowing repetitive sampling. Our tool for initial renal biopsy training and for Lorlatinib in vitro maintenance of already acquired skills has received positive feedback from fellows in major adult and pediatric buy CHIR98014 nephrology training programs. Future controlled studies are needed to establish the efficacy of this simulation training in reducing discomfort and adverse renal biopsy outcomes in patients. Kidney International (2010) 78, 705-707; doi:10.1038/ki.2010.213;

published online 14 July 2010″
“BACKGROUND: Although minimally invasive surgery for intradural tumors offers the potential benefits of less postoperative pain, a quicker recovery, and the avoidance of long-term instability from multilevel laminectomy, there are concerns over whether one can safely and effectively remove intradural extramedullary tumors in a fashion comparable to open techniques and whether the advantages of minimally invasive

surgery are clinically significant.

OBJECTIVE: To review our early experience with minimally invasive techniques for intradural extramedullary tumors of the spine.

METHODS: Thirteen intradural tumors (1 cervical, 6 thoracic, 6 lumbar) in 11 patients were operated on using a muscle-splitting, tube-assisted paramedian oblique approach with hemilaminectomy to access the spinal canal while preserving the spinous process and ligaments. Fluoroscopy and navigation were used to determine the surgical level in all thoracic and lumbar cases.

RESULTS: Satisfactory tumor resection using standard microsurgical techniques was achieved in all but 1 case using a minimally invasive approach. Surgical time and intraoperative blood TCL loss were favorable compared with our open technique cases. There was no postoperative morbidity with the minimally invasive approach, although in 2 patients with tumors in the mid-and upper thoracic spine, the surgical incision was inaccurately placed by 1 level. In 1 case, the approach was converted to open when the tumor could not be found, and postoperatively there was a cerebrospinal fluid leak with infection that required readmission.

CONCLUSION: Intradural extramedullary tumors can be safely and effectively removed using minimally invasive techniques. The pros and cons of minimally invasive vs open surgery are discussed.