V03-05 TREATMENT OF LARGE KIDNEY STONES BY USING ROBOTIC ASSISTED FLEXIBLE URETEROSCOPY

Abstract

You have accessJournal of UrologyUrolithiasis & Endourology1 Apr 2018V03-05 TREATMENT OF LARGE KIDNEY STONES BY USING ROBOTIC ASSISTED FLEXIBLE URETEROSCOPY Remzi Saglam, Anup Patel, Jens Rassweiler, Jan Klein, Yasser Farahat, Abdulqadir Al Zarooni, Selahattin Bedir, Ahmet Müslümanoglu, Zafer Tokatli, and Kemal Sarica Remzi SaglamRemzi Saglam More articles by this author , Anup PatelAnup Patel More articles by this author , Jens RassweilerJens Rassweiler More articles by this author , Jan KleinJan Klein More articles by this author , Yasser FarahatYasser Farahat More articles by this author , Abdulqadir Al ZarooniAbdulqadir Al Zarooni More articles by this author , Selahattin BedirSelahattin Bedir More articles by this author , Ahmet MüslümanogluAhmet Müslümanoglu More articles by this author , Zafer TokatliZafer Tokatli More articles by this author , and Kemal SaricaKemal Sarica More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.830AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES International guidelines universally recommend PCNL as the treatment of choice for large renal stones. In the past decade, many centers have reported on classical retrograde intra-renal surgery for large renal stones. Recently Robotic Assisted Retrograde Intrarenal Surgery provides better stone free rates with some more advantages for the patient, user and the endoscopic device. METHODS This video demonstrates the step-by-step technique and advantages of Avicenna Roboflex robotic assisted retrograde intra-renal surgery (RA-RIRS), the latest iteration of master-slave robotics in this field. Due to reduced invasiveness, the patient, a 50 year old Iraqi general surgeon, preferred this approach over PCNL. Non-contrast CT showed a large (2941.5mm3) left renal stone, with 1076 bone window Hounsfield units. Our previous studies have shown: a) an upper stone volume limit of 4000mm3 with HU of 1000 for RA-RIRS, yielding 89% single-session stone free rate; b) that ureteral access sheath size >11/13Fr allows 35 ml/min. irrigation without raising intra-renal pressure >25 cm water, optimizing safety and vision, while allowing irrigant and dust efflux compared to smaller sheaths. RESULTS The RA-RIRS procedure was uncomplicated. Optimized efficiency led to single stage complete stone fragmentation (stone dusting time 74 minutes, fragmentation efficiency 32 mm3/min). RA-RIRS benefits to the surgeon included improved comfort + ergonomics, touch-screen adjustable endoscope motion scaling, laser fiber positioning, control of respiratory excursion + irrigation flow and less fatigue (no lead protection required). CONCLUSIONS The Avicenna Roboflex allows safe, efficient single stage treatment of renal stones larger than is recommended by current international guidelines. Key design features optimize patient safety and instrument longevity significantly compared to manual operation and by reducing surgeon fatigue, optimizes potential for efficiency. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e323 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Remzi Saglam More articles by this author Anup Patel More articles by this author Jens Rassweiler More articles by this author Jan Klein More articles by this author Yasser Farahat More articles by this author Abdulqadir Al Zarooni More articles by this author Selahattin Bedir More articles by this author Ahmet Müslümanoglu More articles by this author Zafer Tokatli More articles by this author Kemal Sarica More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...