Flexible Cystoscopes Research Articles

Workflow efficiencies for flexible cystoscopy: comparing single-use vs reusable cystoscopes

BackgroundFlexible cystoscopy is a common procedure to diagnose and treat lower urinary tract conditions. Single-use cystoscopes have been introduced to eliminate time-consuming reprocessing and costly repairs. We compared the hands-on labor time differences between flexible reusable cystoscopes versus Ambu’s aScope™ 4 Cysto (aS4C) at a large urology Ambulatory Surgery Center (ASC).MethodsReusable and single-use cystoscopy procedures were shadowed for timestamp collection for setup and breakdown. A subset of reusable cystoscopes were followed through the reprocessing cycle. T-tests were calculated to measure the significance between groups.ResultsThe average hands-on time necessary for reusable cystoscope preparation, breakdown, and pre-cleaning was 4′53″. Of this, 2′53″ were required for preparation, while 2′0″ were required for breakdown and pre-cleaning. The average hands-on time for reprocessing for reusable was 7’1” per cycle. The total time for single-use scopes was 2′22″. Of this, 1′36″ was needed for single-use preparation, and 45 s for breakdown. Compared to reusable cystoscopes, single-use cystoscopes significantly reduced pre and post-procedure hands-on labor time by 2’31”, or 48%. When including reprocessing, total hands-on time was 80% greater for reusable than single-use cystoscopes.ConclusionSingle-use cystoscopes significantly reduced hands-on labor time compared to reusable cystoscopes. On average, the facility saw a reduction of 2′31″ per cystoscope for each procedure. This translates to 20 additional minutes gained per day, based on an 8 procedures per day. Utilizing single-use cystoscopes enabled the facility to reduce patient wait times, decrease turnaround times, and free up staff time.

Single-use digital flexible cystoscope for double J removal versus reusable instruments: a prospective, comparative study of functionality, risk of infection, and costs

BackgroundThe removal of ureteral stent can be performed with disposable or reusable flexible cystoscopes, but limited comparative data are available on functionality, risk of infections, and costs.MethodsWe performed a multicentric, prospective, observational study on patients undergoing in-office ureteral stent removal with Isiris-α® or a reusable Storz™ flexible cystoscope. Study endpoints were the functionality and effectiveness of the devices, the rate of postoperative bacteriuria and UTIs, and the costs of the procedure.ResultsA total of 135 patients were included, 80 (59.2%) treated with reusable cystoscopes and 55 (40.8%) with Isiris-α®. No significant baseline differences between groups were detected. Isiris-α® outperformed the reusable device in terms of quality of vision (p 0.001), manoeuvrability (p 0.001), grasper functionality (p < 0.001), and quality of the procedure (p 0.01). Mean procedure time was shorter with Isiris-α® (p < 0.001) due to a shorter instrument preparation time (p < 0.001). No differences were found in terms of perceived patient pain (p 0.34), nor postoperative bacteriuria or symptomatic UTIs. According to our cost analysis, the in-office procedure performed with Isiris-α® was more expensive (+ 137.8€) but was independent from instrument turnover or disinfection. Among limitations of study we acknowledge the lack of randomization, the use of antibiotic prophylaxis in several patients, and the high rate of missing preoperative urine cultures.ConclusionsIsiris-α® outperforms reusable cystoscopes for in-office ureteral stent removal in terms of total operative time and quality of the procedure, at the cost of being more expensive. No significant differences in postoperative bacteriuria or symptomatic UTIs were found.

Prospective Randomized Trial of Single-Use vs Reusable Cystoscope for Ureteral Stent Removal.

Background: Reusable cystoscopes are associated with risks of cross-contamination, need for chemical reprocessing, mechanical breakdown, maintenance costs, and labor for cleaning. A sterile, single-use cystoscope may reduce or eliminate the source of these infections while also decreasing exposure to reprocessing chemical agents. In this multicenter, randomized trial, we sought to compare single use with reusable endoscopes for ureteral stent removal. Methods: A three-center, randomized, dual-arm postmarket clinical trial was performed to compare the single-use cystoscope (Ambu A/S) with standard-of-care flexible reusable cystoscopes for outpatient ureteral stent removal. A total of 102 patients were randomized and evaluated from baseline through day 10 postprocedure. Primary endpoint was successful stent removal. Secondary endpoints were time from preparation to disposal/reprocessing, adverse events (AEs), and clinician satisfaction. Results: A total of 102 subjects were randomized in a 1:1 manner. The successful stent removal rate was 51/51 (reusable) and 50/51 (single use). One patient required the conversion to reusable cystoscope owing to grasper passage issue. Median time from prep for the procedure to disposal/prep for reprocessing was 10.2 minutes for the single use and 18.4 minutes for the reusable (p < 0.001). There was no difference in clinician satisfaction between both arms. There was no difference in AEs between arms and no device causal attribution for any AE reports. There was one serious AE necessitating hospitalization for infection in the reusable arm. Conclusion: The randomized-controlled trial of single-use cystoscopes vs reusables showed comparable device success with significant time savings for single use and equivalent clinician satisfaction. The study was registered on clinicaltrials.gov database (NCT04829461) on April 2, 2021.

Pulling the plug on a pseudomonas outbreak: ancillary equipment as vectors of infection

Outbreaks of infection related to flexible endoscopes are well described. However, flexible endoscopy also requires the use of ancillary equipment such as irrigation plugs. These are potential vectors of infection but are infrequently highlighted in the literature. This paper reports a cystoscopy-associated outbreak of Pseudomonas aeruginosa from contaminated irrigation plugs in a UK tertiary care centre. Laboratory, clinical and decontamination unit records were reviewed, and audits of the decontamination unit were performed. Flexible cystoscopes and irrigation plugs were assessed for contamination. Retrospective and prospective case finding was performed utilizing the microbiology laboratory information management system. Available P.aeruginosa isolates underwent variable nucleotide tandem repeat (VNTR) typing. Confirmed cases were defined as P.aeruginosa infection with an identical VNTR profile to an outbreak strain. Three strains of P.aeruginosa were isolated from five irrigation plugs but none of the flexible cystoscopes. No acquired resistance mechanisms were detected. Fifteen confirmed infections occurred, including bacteraemia, septic arthritis and urinary tract infection. While failure of decontamination likely occurred because the plugs were not dismantled prior to reprocessing, the manufacturer's reprocessing instructions were also incompatible with standard UK practice. The Medicines and Healthcare Products Regulatory Agency was informed. A field safety notice was issued, and the manufacturer issued updated reprocessing instructions. Ancillary equipment can represent an important vector for infection, and should be considered during outbreak investigations. Users should review the manufacturer's instructions for reprocessing ancillary equipment to ensure that they are compatible with available procedures.

Are single-use flexible cystoscopes environmentally sustainable? A lifecycle analysis

Objective: Single-use flexible cystoscopes provide a safe and cost-effective evolution to current practice. However, the environmental impact of single-use devices needs to be considered in a healthcare system that is being increasingly scrutinised for its carbon footprint. We performed a single-centre simplified lifecycle analysis to compare the carbon footprint of the single-use Ambu® aScope™ 4 Cysto System (Ambu®) with the reusable Olympus CYF-VH flexible video-cystoscope (Olympus). Methods: Manufacturing, transportation and waste costs were calculated for the Ambu® cystoscope. Manufacturing costs incorporating the average lifecycle of the reusable cystoscope was included in the carbon footprint calculation for the Olympus reusable cystoscope as were waste costs and re-processing costs using the Soluscope 3 automatic endoscope re-processor that is used in our centre. Results: Results demonstrate that Ambu® cystoscopes are a carbon-friendly alternative to reusable Olympus cystoscopes, with a 36% lower carbon footprint. The carbon footprint of the Ambu® scope is 1.43 kg CO2 compared with 2.22 kg CO2 for the reusable Olympus cystoscope. These results may vary from centre to centre depending on the cystoscope re-processor used. Conclusion: The Ambu® single-use flexible cystoscopes provide a carbon-friendly alternative to Olympus CYF-VH reusable cystoscopes. Level of evidence: IV

HSD40 Workflow Efficiencies for Flexible Cystoscopy: Comparing Single-Use Vs Reusable Cystoscopes

Flexible cystoscopy is a common procedure that is performed to diagnose and treat lower urinary tract conditions. Single-use cystoscopes have been introduced to eliminate time-consuming reprocessing, costly repairs, and potential cross-contamination that occur between cystoscopies with reusable scopes. We aimed to compare the hands-on labor time differences between flexible reusable cystoscopes versus single-use cystoscopes at a large urology Ambulatory Surgery Center (ASC).

Response to Rizan et al.: "The Carbon Footprint of Single-Use Flexible Cystoscopes Compared with Reusable Cystoscopes"-Clarification of Methods Due to Apparent Misinterpretation.

N/A.

MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL

You have accessJournal of UrologyCME1 Apr 2023MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL Brett Johnson, Jay Raman, Best Sara, and Yair Lotan Brett JohnsonBrett Johnson More articles by this author , Jay RamanJay Raman More articles by this author , Best SaraBest Sara More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reusable cystoscopes are associated with risks of cross-contamination, need for chemical reprocessing, mechanical breakdown, manpower for cleaning and maintenance costs. A sterile, single use cystoscope may reduce or eliminate the source of these infections, while also decreasing exposure to reprocessing chemical agents. This multicenter, prospective randomized trial compared single-use vs. reusable endoscope for removal of ureteral stents. METHODS: The evaluation of a single-use cystoscope (Ambu A/S) was completed in a prospective, randomized, dual-arm post-market clinical trial to directly compare its performance to standard of care (SOC) flexible reusable cystoscopes in the removal of ureteral stents in an outpatient setting. 102 patients were evaluated from baseline through day 10 post-procedure at three investigative sites. The primary endpoint was the success rate of the stent removal procedures, delineated by single-use or reusable cystoscope. Secondary endpoints included time from preparation to disposal or reprocessing preparation, urologic adverse events 0-10 days, and a post-procedure clinician satisfaction survey. RESULTS: There were 102 subjects, randomized 1:1 between the single-use scope and SOC reusable scope. The successful stent removal rate was 51/51 for SOC group and 50/51 for single-use group (p=1.00). One patient required the conversion to a reusable scope due to a grasper passage issue with the index scope. There was no statistical difference in the time from scope insertion to procedure completion between the study arms. Median time from prep for the procedure to disposal/prep for reprocessing was 611 sec. for the single-use and 1105 sec. for the reusable (p=0.00). Reprocessing time was not evaluated in study. The 5-point survey demonstrated no difference in clinician satisfaction between both arms across all parameters addressed, as seen in the Clinician Satisfaction Table. There was no difference in adverse events between arms and no device causal attribution for any adverse events reports. One serious adverse event required hospitalization for infection in the SOC arm. CONCLUSIONS: The RCT of single-use cystoscopes vs. reusables showed comparable device success with significant time savings for single-use and equal clinician satisfaction. Source of Funding: Ambu USA sponsored this trial. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e361 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brett Johnson More articles by this author Jay Raman More articles by this author Best Sara More articles by this author Yair Lotan More articles by this author Expand All Advertisement PDF downloadLoading ...

PD13-03 A CYSTOSCOPY ARTIFICIAL INTELLIGENCE SYSTEM THAT CAN BE USED WITH CYSTOSCOPES PRODUCED BY DIFFERENT MANUFACTURERS

You have accessJournal of UrologyCME1 Apr 2023PD13-03 A CYSTOSCOPY ARTIFICIAL INTELLIGENCE SYSTEM THAT CAN BE USED WITH CYSTOSCOPES PRODUCED BY DIFFERENT MANUFACTURERS Atsushi Ikeda, Hirokazu Nosato, Shogo Takaoka, Hiromitsu Negoro, Hidenori Sakanashi, Masahiro Murakawa, and Hiroyuki Nishiyama Atsushi IkedaAtsushi Ikeda More articles by this author , Hirokazu NosatoHirokazu Nosato More articles by this author , Shogo TakaokaShogo Takaoka More articles by this author , Hiromitsu NegoroHiromitsu Negoro More articles by this author , Hidenori SakanashiHidenori Sakanashi More articles by this author , Masahiro MurakawaMasahiro Murakawa More articles by this author , and Hiroyuki NishiyamaHiroyuki Nishiyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystoscopy is essential for the treatment of bladder cancer. However, its diagnostic accuracy is highly dependent on the experience and knowledge of the urologist. We are developing a real-time examination support system that can be connected to existing bladder endoscopy systems with a single cable to support the diagnosis of bladder cancer using artificial intelligence. During this study, we adapted our AI-support system trained cystoscopy images with a single manufacturer and validated its use with cystoscopes created by the other two manufacturers. METHODS: The training data for our system with the ResNet50 model as the deep learning model comprised 2102 white-light still images (normal: 1671; tumors: 431) obtained using an Olympus VHA cystoscope. Based on the Olympus training data, our system was used with flexible cystoscopes manufactured by Karl Storz and Ambu. Two data sets containing four cases with the Karl Storz HD-VIEW and seven with the Ambu aScope 4 Cysto were used for verification. We compared the detection rate for each lesion of each case by converting the moving images to still images and comparing them with the annotated data (the correct data obtained by the expert urologist). RESULTS: The moving images obtained using the cystoscopes manufactured by Karl Storz and Ambu resulted in 3,767 and 3,713 still images corresponding to 16 and 40 annotated tumors, respectively. Furthermore, the mean detection rates of the cystoscopes manufactured by Karl Storz and Ambu were 98.96% and 77.18%, respectively. CONCLUSIONS: Our system using images obtained with the Olympus cystoscope as training data also showed relatively good lesion detection rates when evaluating images obtained using cystoscopes manufactured by Karl Storz and Ambu. Additional training with small data set of target cystoscopy images could improve the accuracy of our system, thus providing diagnostic support for all cystoscopy systems and resulting in efficient observations and diagnoses of tumors. Source of Funding: This study is based on results obtained from a project, JPNP20006, commissioned by the New Energy and Industrial Technology Development Organization (NEDO) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e406 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Atsushi Ikeda More articles by this author Hirokazu Nosato More articles by this author Shogo Takaoka More articles by this author Hiromitsu Negoro More articles by this author Hidenori Sakanashi More articles by this author Masahiro Murakawa More articles by this author Hiroyuki Nishiyama More articles by this author Expand All Advertisement PDF downloadLoading ...

Environmental impact of single-use and reusable flexible cystoscopes.

To compare the carbon footprint and environmental impact of single-use and reusable flexible cystoscopes. We analysed the expected clinical lifecycle of single-use (Ambu aScope™ 4 Cysto) and reusable (Olympus CYF-V2) flexible cystoscopes, from manufacture to disposal. Performance data on cumulative procedures between repairs and before decommissioning were derived from a high-volume multispecialty practice. We estimated carbon expenditures per-case using published data on endoscope manufacturing, energy consumption during transportation and reprocessing, and solid waste disposal. A fleet of 16 reusable cystoscopes in service for up to 135 months averaged 207 cases between repairs and 3920 cases per lifecycle. Based on a manufacturing carbon footprint of 11.49 kg CO2 /kg device for reusable flexible endoscopes and 8.54 kg CO2 /kg device for single-use endoscopes, the per-case manufacturing cost was 1.37 kg CO2 for single-use devices and 0.0017 kg CO2 for reusable devices. The solid mass of single-use and reusable devices was 0.16 and 0.57 kg, respectively. For reusable devices, the energy consumption of reusable device reprocessing using an automated endoscope reprocessor was 0.20 kg CO2 , and per-case costs of device repackaging and repair were 0.005 and 0.02 kg CO2 , respectively. The total estimated per-case carbon footprint of single-use and reusable devices was 2.40 and 0.53 kg CO2 , respectively, favouring reusable devices. In this lifecycle analysis, the environmental impact of reusable flexible cystoscopes is markedly less than single-use cystoscopes. The primary contributor to the per-case carbon cost of reusable devices is energy consumption of reprocessing.

Management of complex urethral stricture in public health facilities in developing nations in the 21st century

Management of complex urethral stricture in public health facilities in developing nations in the 21^st century

Life Cycle Assessment of Reusable and Disposable Cystoscopes: A Path to Greener Urological Procedures

BackgroundThe environmental impact of reusable and disposable devices is unclear; reuse is expected to reduce the carbon footprint, but the environmental impact of reprocessing of reusable devices is increasingly being questioned. ObjectiveThe aim was to provide the first rigorous life cycle assessment of reusable and disposable flexible cystoscopes. Design, setting, and participantsWe performed a life cycle assessment of reusable flexible cystoscopes and the aS4C single-use cystoscope (aScope; Ambu, Ballerup, Denmark). For the aScope, the complete lifespan of the scope was evaluated, including raw material extraction, material formulation, component production, product assembly, distribution, transportation after use, and final disposal. For reusable cystoscopes, we limited our analysis to their reprocessing, using a model consisting of standard high-level disinfection with peracetic acid. The environmental impact was evaluated by an independent third-party consulting company APESA (Technopole Hélioparc, Pau, France) dedicated to such risk assessments. Outcome measurements and statistical analysisThe environmental footprint of both cystoscopes was assessed using five environmental impact categories, namely, climate change, mineral resource depletion, ecotoxicity, acidification, and eutrophication. To perform the life cycle assessment, Simapro v9.3.3 software was used and the Ecoinvent v3.5 database was employed as the primary life cycle inventory database. A Monte Carlo analysis was used to account for the inherent uncertainty in life cycle inventory data and the variability in material and energy consumption for each type of flexible cystoscope. Results and limitationsBy only comparing the disinfection reprocessing of reusable cystoscopes with the complete lifespan of the single-use cystoscope, the use of the aScope would allow a reduction of at least 33% in the climate change category, 50% in the mineral resources’ depletion category, 51% in the ecotoxicity category, 71% in the acidification category, and 49% in the eutrophication category. Our results cannot be generalized to all health care facilities as we studied only one type of reprocessing method and one disposable flexible cystoscope. ConclusionsDisinfection reprocessing of reusable cystoscopes was found to have a significantly larger environmental footprint and impact than the whole lifespan of the single-use cystoscope aScope. Patient summaryUsing a cradle-to-grave life cycle analysis, we showed that the environmental footprint of a flexible cystoscopy procedure can be reduced by using a disposable cystoscope instead of a reusable cystoscope.

EDITORIAL COMMENT

This is an outstanding micro-costing analysis comparing the cost of disposal vs multiuse units which concludes that for this tertiary academic center disposable flexible cystoscopes resulted in a lower cost.1 Only one of the 7 authors was a consultant for the device being investigated, which helps to minimize investigator bias, and measured user satisfaction with the disposable cystoscope during the 3 months of study was high. The authors are to be commended for providing this information that can be used by other centers in consideration of this decision and the study adds to a growing body of literature on this topic.

921 Establishing the Role of Bedside Disposable Cystoscopes for Emergency Urethral Catheterisation

Abstract Introduction Where urethral catheterisation fails, cystoscopy may enable urologists’ adequate views to identify the urethral channel. Traditionally this has required a slot on the emergency operating list. Our district general hospital introduced single use flexible cystoscopes to allow for bedside catheterisation and here we present our experience. Method Data was collected prospectively each time a disposable scope was used for urethral catheterisation over a 4-month period. A form was designed and distributed to all six clinicians who used the device. We evaluated both assessment of the scope and the success of the procedure. Results 16 forms were collected. Overall, the experience was described as good in 14 out of 16 instances. Catheterisation was successful in 14 cases. 13 forms described the image of the scope as being average, with three describing it as good. 10 forms reported good flexibility, with six reporting it as average. On seven occasions the clinician denied difficulty passing the scope through the narrowing. Six clinicians found the views of the bladder adequate although in eight of 16 cases, the bladder was not visualised. Not all feedback was positive with some clinicians reporting weak irrigation and the challenge of the scope having only one channel. Discussion The disposable scope showed high efficacy for insertion of a urethral catheter in cases of difficult urethral catheterisation. Clinicians highlighted good lighting and irrigation as well as flexibility. The introduction of disposable cystoscopes saves resources as well as being financially sensible. we will continue its use in our departments.

Comment on: "The Carbon Footprint of Single-Use Flexible Cystoscopes Compared with Reusable Cystoscopes" by D. Hogan et al.

Comment on: "The Carbon Footprint of Single-Use Flexible Cystoscopes Compared with Reusable Cystoscopes" by D. Hogan et al.

High-level disinfection evaluation in the ambulatory setting

High level disinfection (HLD) is a complex process, requiring appropriate materials and highly trained personnel. An investigation of the HLD process was performed at an outpatient urology practice upon notification of expired chemical test strips being utilized. Infection Prevention (IP) identified various breaches in the reprocessing of flexible cystoscopes and transrectal prostate biopsy probes. Contributing factors identified were gaps in staff training, availability of all necessary supplies and staff supervision.

Cost and Environmental Impact of Disposable Flexible Cystoscopes Compared to Reusable Devices.

Objectives: To quantify the environmental impact and costs associated with flexible cystoscopy procedures from an institutional perspective, with particular attention for the comparison between disposable and reusable cystoscopes. Materials and Methods: This is a single-center retrospective study, including all flexible cystoscopies performed between 2020 and 2021 using reusable or single-use devices. The Ambu aS4C single-use cystoscope (Ballerup, Denmark) gradually replaced the reusable device in our center, with exclusive use from October 2021. Reprocessing costs for reusable cystoscopes were evaluated using a micro-costing approach. The environmental impact of reusable and disposable cystoscopes was assessed by the amount of waste and water consumed for each procedure. Results: A total of 1578 flexible cystoscopies using reusable cystoscopes were performed in 2020, and 550 cystoscopies were performed using the Ambu aS4C cystoscope from October 2021 to February 2022. The cost of flexible cystoscopy with a reusable and a disposable endoscope was €196 and €192, respectively. The amount of waste generated by reprocessing reusable and disposable cystoscopes was 800 and 200 g per procedure, respectively. Water consumption for sterilization of the reusable cystoscope was 60 L per procedure, whereas no water consumption was required with the Ambu aS4C cystoscope. A 100% Ambu aS4C cystoscope use would reduce waste generation and water consumption by 946.8 kg and 94.68 m3 per year. Conclusion: In this study, implementing a strategy of using 100% disposable cystoscopes was associated with similar costs and reduced waste generation and water consumption compared to reusable devices. Future studies are needed to compare the carbon footprint of these devices, through a comprehensive and rigorous life cycle assessment from manufacturing to recycling.

The Carbon Footprint of Single-Use Flexible Cystoscopes Compared with Reusable Cystoscopes.

Introduction: Single-use devices for endourologic procedures are becoming more popular. The environmental impact of single-use instruments is relatively unknown. This study aimed to compare the carbon footprint of single-use vs reusable flexible cystoscopes based on waste production and estimated carbon emissions. Methods: An analysis of the solid waste produced when using the aScope™ 4 Cysto (Ambu®) single-use flexible cystoscope compared with the reusable Cysto-Nephro Videoscope CYF-VA2 (Olympus®) was performed. The solid waste generated was measured (grams) and recorded as either recyclable, landfill, or contaminated, and carbon dioxide (CO2) produced by disposal, manufacture, and cleaning was calculated. Results: A total of 40 flexible cystoscopies (20 single-use and 20 reusable) were analyzed. Median total weight of waste produced was 622 g (interquartile range [IQR] 621-651) for the single-use cystoscope compared with 671.5 g (IQR 659-677.5) for the reusable cystoscope (p < 0.0001). More waste was disposed of by incineration after single-use than reusable cystoscopy (496 g [IQR 495-525] vs 415 g [IQR 403-421.5], p < 0.0001). However, more waste went to landfill after reusable cystoscopy (256 g ± 0 vs 126 g ± 0, p < 0.0001). There was no difference in weight of waste produced based on the indication for cystoscopy (p = 0.1570). A total of 2.41 kg of CO2 (IQR 2.40-2.44) was produced per case for the single-use flexible cystoscope compared with 4.23 kg of CO2 (IQR 4.22-4.24) for the reusable cystoscope (p < 0.0001). Conclusion: Environmental accountability is essential in modern health care. This study highlights that disposable flexible cystoscopes have a significantly lower impact on the environment in terms of carbon footprint and landfill. We propose that environmental impact studies should be a routine part of device development for a sustainable future.

Real-Time Camera Localization during Robot-Assisted Telecystoscopy for Bladder Cancer Surveillance

Telecystoscopy can lower the barrier to access critical urologic diagnostics for patients around the world. A major challenge for robotic control of flexible cystoscopes and intuitive teleoperation is the pose estimation of the scope tip. We propose a novel real-time camera localization method using video recordings from a prior cystoscopy and 3D bladder reconstruction to estimate cystoscope pose within the bladder during follow-up telecystoscopy. We map prior video frames into a low-dimensional space as a dictionary so that a new image can be likewise mapped to efficiently retrieve its nearest neighbor among the dictionary images. The cystoscope pose is then estimated by the correspondence among the new image, its nearest dictionary image, and the prior model from 3D reconstruction. We demonstrate performance of our methods using bladder phantoms with varying fidelity and a servo-controlled cystoscope to simulate the use case of bladder surveillance through telecystoscopy. The servo-controlled cystoscope with 3 degrees of freedom (angulation, roll, and insertion axes) was developed for collecting cystoscope videos from bladder phantoms. Cystoscope videos were acquired in a 2.5D bladder phantom (bladder-shape cross-section plus height) with a panorama of a urothelium attached to the inner surface. Scans of the 2.5D phantom were performed in separate arc trajectories each of which is generated by actuation on the angulation with a fixed roll and insertion length. We further included variance in moving speed, imaging distance and existence of bladder tumors. Cystoscope videos were also acquired in a water-filled 3D silicone bladder phantom with hand-painted vasculature. Scans of the 3D phantom were performed in separate circle trajectories each of which is generated by actuation on the roll axis under a fixed angulation and insertion length. These videos were used to create 3D reconstructions, dictionary sets, and test data sets for evaluating the computational efficiency and accuracy of our proposed method in comparison with a method based on global Scale-Invariant Feature Transform (SIFT) features, named SIFT-only. Our method can retrieve the nearest dictionary image for 94–100% of test frames in under 55[Formula: see text]ms per image, whereas the SIFT-only method can only find the image match for 56–100% of test frames in 6000–40000[Formula: see text]ms per image depending on size of the dictionary set and richness of SIFT features in the images. Our method, with a speed of around 20 Hz for the retrieval stage, is a promising tool for real-time image-based scope localization in robotic cystoscopy when prior cystoscopy images are available.

MP039 - The carbon footprint of single-use flexible cystoscopes compared to reusable cystoscopes.

MP039 - The carbon footprint of single-use flexible cystoscopes compared to reusable cystoscopes.