MP32-06: Feasibility of laser lithotripsy using robotic retrograde intrarenal surgery system easyUretero and Auriga XL Holmium laser in porcine model

Hyun Ho Han*, Young Joon Moon, Seoul, Korea, Republic of, Hae Do Jung, Gunpo, Korea, Republic of, Joonhwan Kim, Byungsik Cheon, Jungmin Han, Daejeon, Korea, Republic of, Sung Yong Cho, Seoul, Korea, Republic of, Dong-Soo Kwon, Daejeon, Korea, Republic of, Joo Yong Lee, Seoul, Korea, Republic of

Introduction: Retrograde intrarenal surgery (RIRS) using flexible ureteroscope is a standard treatment for renal stone < 2cm. The objective of this animal study was to evaluate the safety and feasibility laser lithotripsy using a robotic RIRS system easyUretero (EasyEndo Surgical Inc., Daejeon, Korea) and Auriga XL™ Holmium laser (Boston Scientific) in a porcine model of kidney stone.

Methods: Four female pigs aged 6 months were used. Three urologic surgeons representing RIRS beginner, intermediate and expert participated. Manual RIRS was performed in two animals, and robotic RIRS using the easyUretero system was performed in the other two animals. Under general anesthesia, animals were placed in the dorsal lithotomy position. Nephrostomy tract was created ventrally under ultrasound-guidance and calcium stones sized 1.0-1.5cm were inserted at renal calyces via 18Fr Amplatz renal sheath using 15Fr Mini Nephroscope (Olympus). Ureteral access sheath was placed. For manual RIRS, surgeons operated the LithoVue (Boston Scientific) flexible ureteroscope (Fig 1). For robotic RIRs, the LithoVue was attached to the robotic slave device. Lasering and stone retrieval time were measured. Kidney and ureter were inspected for injury at the end of each session.

Results: For RIRS expert, both lasering and stone retrieval by manual RIRS took shorter time than robotic RIRS (22.8±11.0 vs 234.5±102.5sec/stone, p=0.02; 41.5±0.5 vs 79.3±8.1sec/stone, p = 0.02). For RIRS intermediate and beginners, lasering time and stone retrieval time were not significantly different between manual and robotic procedure (127.8±93.2 vs 241.8sec/stone, p=0.14; 85±30.5 vs 96.1±32.7sec/stone, p=0.63). All stones were successfully removed. Grade 1 ureteral injury occurred in manual cases, and grade 1 ureteral and renal injuries occured in robotic cases.

Conclusions: Laser lithotripsy using the easyUretero robotic RIRS system was feasible and in porcine model, even for the less-experienced surgeons.

Source of Funding: EasyEndo Surgical, Inc.