Clinical Assistant Professor Yonsei University College of Medicine
Introduction: Guidelines recommend retrograde intrarenal surgery (RIRS) is used as the first-line treatment for patients with renal stone < 2 cm. All new robotic endoscopic platform system easyUretero was developed for robotic RIRS. We evaluated the feasibility and safety of renal stone retrieval using robotic RIRS in porcine model.
Methods: Six female pigswere used for our in vivo study. All procedures were performed under general anesthesia with endotracheal intubation. LithoVue was attached to easyUretero system. Before stone retrieval, 0.3 cm sized phantom stones were inserted into the kidneys through the ureteral access sheath. In 3 pigs, manual RIRS were performed and in other 3 pigs, robotic RIRS were performed. Three surgeons including high, intermediate and low experienced urologists performed extraction for 10 stones in each session. The time of stone retrieval, and ureteral injury grades after removal of access sheath were evaluated in each session.
Results: The mean age of 6 pigs was 6 months and weight was 48.33±0.82 kg. The mean stone retrieval time were 399.9±185.4 sec in manual RIRS and 1127.6±374.5 sec in robotic RIRS using easyUretero (P <0.001). Stone retrieval time in manual and robotic RIRS were 209.7±74.2 sec and 772.0±120.8 sec in high experience surgeon (P=0.002), 380.3±48.4 sec and 1226.7±329.4 sec in intermediate experienced surgeon (P=0.044) and 609.7±94.0 sec and 1384.0±367.1 sec in low experienced surgeon (P=0.024). Questionnaire for usability showed high satisfaction in shoulder, forearm, wrist and thumb fatigue in robotic RIRS. Postoperative ureteral injury showed Grade 0 in manual cases and Grade 0, 1 and 2 in robotic cases. However, ureteral injury in robotic cases could be related to ureteral access sheath insertion.
Conclusions: Robotic RIRS using the easyUretero system showed longer time for stone retrieval compared to manual RIRS, but showed high satisfaction in operators’ fatigue.
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