PD16-02 MODIFIED ERGONOMIC LITHOTRIPSY (MEL): A PROSPECTIVE SINGLE CENTRE STUDY DEMONSTRATING A NOVEL METHOD FOR RETROGRADE INTRARENAL SURGERY (RIRS) TO ACHIEVE HIGH STONE FREE RATES WITHOUT SURGEON FATIGUE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2017PD16-02 MODIFIED ERGONOMIC LITHOTRIPSY (MEL): A PROSPECTIVE SINGLE CENTRE STUDY DEMONSTRATING A NOVEL METHOD FOR RETROGRADE INTRARENAL SURGERY (RIRS) TO ACHIEVE HIGH STONE FREE RATES WITHOUT SURGEON FATIGUE VINEET GAUHAR, SARVAJIT BILIGERE, GIRIDER SWAMINATHAN, RUO XUAN GOH, and CHIN TIONG HENG VINEET GAUHARVINEET GAUHAR More articles by this author , SARVAJIT BILIGERESARVAJIT BILIGERE More articles by this author , GIRIDER SWAMINATHANGIRIDER SWAMINATHAN More articles by this author , RUO XUAN GOHRUO XUAN GOH More articles by this author , and CHIN TIONG HENGCHIN TIONG HENG More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.836AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES RIRS in larger stones and complex renal anatomy when done conventionally challenges a surgeon, causing fatigue leading to poor outcomes and stone free rates.The Avicenna Robot addresses precision and surgeon fatigue. However, cost is a limiting factor. We used the MEL position with definitive maneuvers intra-operatively allowing focused lithotripsy to improve higher stone free rates with the hypothesis of being more cost efficient. - To describe,assess and review outcomes of our institute at Singapore doing RIRS in a modified lithotomy position to improve ergonomics for the endourologist especially in large calculi and complex anatomy. - To assess surgeon fatigue and stone free rates(SFR) and the need for ancillary equipment and procedures. METHODS 100 Renal units had MEL from July 2015 to November 2016. A diagnostic retrograde pyelogram and semi rigid ureteroscopy was followed by a 11-13fr or 12/14fr 42-45 cm access sheath insertion in men and 35-36 cm in women. Position: Lithotomy with head up and table incline at 35 degrees, respiratory rate controlled at 7-8 per minute. 20 minutes prior to completion of procedure 10 mg furosemide was given to induce diuresis. Surgeon stool was raised such that hands were at the level of access sheath to relax shoulders and allow normal maneuvering without stress on flexible scope. SFR defined as residual fragments less than 3 mm was determined by CT scan 1 month or 3 months after surgery. RESULTS All 100 cases involving 3 primary surgeons had successful RIRS by MEL technique with minimal fatigue. Mean operative time for large stones 90.8 min Mean laser time 53.6 min. 18% cases needed a basket to re-position stones. Rate of sepsis 3% Average hospital stay was 2 days Scopes serviced: 2 No loss in scope functionality. Good visibility maintained. CONCLUSIONS Having reproduced the MEL technique for 100 cases with no added morbidity and good outcomes, we believe that our aims were successful. We propose this technique as an alternative to standard RIRS. It definitely minimizes need for accessories is cost and surgeon effective,unless Avicenna becomes the cheapest alternative way forward in future. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e347 Advertisement Copyright & Permissions© 2017MetricsAuthor Information VINEET GAUHAR More articles by this author SARVAJIT BILIGERE More articles by this author GIRIDER SWAMINATHAN More articles by this author RUO XUAN GOH More articles by this author CHIN TIONG HENG More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...