MP50-19 INTRA-RENAL PRESSURES DURING RA-RIRS (ROBOTIC ASSISTED RETROGRADE INTRA-RENAL SURGERY): A CRITICAL EVALUATION BASED ON URETERAL ACCESS SHEATH (UAS) SIZE AND IRRIGATION FLOW RATE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2017MP50-19 INTRA-RENAL PRESSURES DURING RA-RIRS (ROBOTIC ASSISTED RETROGRADE INTRA-RENAL SURGERY): A CRITICAL EVALUATION BASED ON URETERAL ACCESS SHEATH (UAS) SIZE AND IRRIGATION FLOW RATE Nida Zafer Tokatli, Kemal Sarica, Ahmet Sinan Kabakci, Remzi Saglam, and Anup Patel Nida Zafer TokatliNida Zafer Tokatli More articles by this author , Kemal SaricaKemal Sarica More articles by this author , Ahmet Sinan KabakciAhmet Sinan Kabakci More articles by this author , Remzi SaglamRemzi Saglam More articles by this author , and Anup PatelAnup Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1607AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate effects of varying UAS sizes (10/12F - 12/14F) and changing irrigation flow rates modulated by custom designed pump system, on RA-RIRS intra-renal pressure levels. METHODS To evaluate changing irrigation flow rate effects on intra-renal pressure values during RA-RIRS, a customized pump system adjusted for stepwise flow rate increases between 5-60 ml/min, was connected to two different flexible uretero-renoscopes (FlexX2 and FlexXC, Karl Storz GmbH, Germany) coupled to the Avicenna Roboflex. Free channel flow rates through each instrument working channel were measured several times for a set irrigant height. After assessing baseline flow rates with constant flow, the study was repeated using a custom designed pump system (ELMED, Turkey). RA-RIRS intrarenal pressures were measured percutaneously using 4 different manufacturer's access sheaths positioned in the proximal ureter (9.5/11.5F Cook, 10/12F Rocamed, 10.7/12.7F Cook and 12/14F Boston Scientific). Studies were repeated subsequently in the Minnesota University kidney model with calyceal puncture, as with patients. RESULTS Smaller sized UAS ( 9.5/11.5F) limited irrigant efflux along the outer side and resulted in increased intrarenal pressures in a short time even without a pump system. For larger UAS sizes, intrarenal pressures continued to remain <30cmH2O even with irrigation rates of up to 20ml/min. Lastly, when 12/14F UAS was used, intrarenal pressures were < 30cmH2O despite irrigation flow rates up to 60ml/min. CONCLUSIONS Using an appropriate sized UAS during RA-RIRS is of paramount importance. Careful irrigant flow rate adjustment with precisely controlled intrarenal pressure values, preferably using a specially designed pump system, can enable surgeons to perform RA-RIRS safely with clear vision with larger UAS sizes. This approach may increase stone free rates, and reduce pressure build-up plus infection-related complication risk, particularly in cases with large and complex stones needing longer operating times. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e691 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nida Zafer Tokatli More articles by this author Kemal Sarica More articles by this author Ahmet Sinan Kabakci More articles by this author Remzi Saglam More articles by this author Anup Patel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...