PD41-05 INITIAL CLINICAL EXPERIENCE OF MINI-PERCUTANEOUS NEPHROLITHOTOMY (PCNL) WITH URETEROSCOPIC (URS) LITHOTRIPSY AND SYNCHRONOUS PERCUTANEOUS EVACUATION OF FRAGMENTS USING A STEERABLE SUCTION DEVICE

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (PD41)1 Sep 2021PD41-05 INITIAL CLINICAL EXPERIENCE OF MINI-PERCUTANEOUS NEPHROLITHOTOMY (PCNL) WITH URETEROSCOPIC (URS) LITHOTRIPSY AND SYNCHRONOUS PERCUTANEOUS EVACUATION OF FRAGMENTS USING A STEERABLE SUCTION DEVICE Mihir Desai, Abhishek Singh, Arvind Ganpule, Ravindra sabnis, Mahesh Desai, and Jaime Landman Mihir DesaiMihir Desai More articles by this author , Abhishek SinghAbhishek Singh More articles by this author , Arvind GanpuleArvind Ganpule More articles by this author , Ravindra sabnis Ravindra sabnis More articles by this author , Mahesh DesaiMahesh Desai More articles by this author , and Jaime LandmanJaime Landman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002051.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current retrograde ureteroscopic (URS) stone management strategies are counterintuitive as irrigation disperses fragments during lithotripsy and extraction. Inability to contain and extract dust and fragments during URS leads to low stone-free rates. Current antegrade Percutaneous Nephrolithotomy (PCNL) procedures (up to 30 Fr) require rigid instrumentation for fragmentation and suction. We present an innovative procedural concept that combines a novel percutaneous, flexible, and steerable suction catheter paired with URS lithotripsy, along with integrated fluid management of both irrigation and suction. We report first-in-man feasibility data using this system (developed by Auris Health, Redwood City, CA). METHODS: The mini-PCNL with URS lithotripsy procedures were performed in a modified supine lithotomy position. Following percutaneous access, a 18Fr percutaneous sheath was placed into the calyx. The system’s 15 Fr steerable suction catheter was inserted through the percutaneous sheath, and used a fluid management tower to coordinate irrigation and suction. URS lithotripsy was performed by a second physician through a ureteral access sheath. Simultaneously, the steerable percutaneous suction catheter extracted fragments while attracting and stabilizing these fragments to prevent retropulsion. RESULTS: Ten patients underwent the mini-PCNL with URS lithotripsy procedure. Mean age was 42±15 years, BMI was 22±5.9 kg/m2, and stone burden was 19.5±7.4 mm. Mean procedure time was 61±26 minutes. All procedures were technically successful, without device-related complications. Nine procedures were tubeless, and 1 patient required a nephrostomy tube due to oozing during the procedure. There were 4 Clavien 1 complications (3 mild post-procedure fevers, 1 transient positional injury). Stone-free rate was 70% at 48 hours, and 90% at 1 month, as assessed by thin slice CT imaging. CONCLUSIONS: This study demonstrates the feasibility of combining mini-PCNL with URS lithotripsy to achieve simultaneous percutaneous suction of debris and fragments during URS lithotripsy. This procedural approach resulted in a high stone-free rate using a single percutaneous access tract. Current work is underway to perform the procedure robotically. Source of Funding: Auris Surgical © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e682-e682 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mihir Desai More articles by this author Abhishek Singh More articles by this author Arvind Ganpule More articles by this author Ravindra sabnis More articles by this author Mahesh Desai More articles by this author Jaime Landman More articles by this author Expand All Advertisement Loading ...