V11-02 AVICENNA ROBOFLEX, FOR ROBOTIC ASSISTED RETROGRADE INTRARENAL LASER LITHOTRIPSY OF THE KIDNEY STONES, LARGER THAN 2 CM.

摘要

You have accessJournal of UrologyUrolithiasis1 Apr 2017V11-02 AVICENNA ROBOFLEX, FOR ROBOTIC ASSISTED RETROGRADE INTRARENAL LASER LITHOTRIPSY OF THE KIDNEY STONES, LARGER THAN 2 CM. Anup Patel, Jan Klein, Yasser Farahat, Nida Zafer Tokatli, Ahmet Sinan Kabakci, and Remzi Saglam Anup PatelAnup Patel More articles by this author , Jan KleinJan Klein More articles by this author , Yasser FarahatYasser Farahat More articles by this author , Nida Zafer TokatliNida Zafer Tokatli More articles by this author , Ahmet Sinan KabakciAhmet Sinan Kabakci More articles by this author , and Remzi SaglamRemzi Saglam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2991AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic assisted retrograde intra-renal surgery (RA-RIRS) with the Avicenna Roboflex allows safe, comfortable, and remote control, of all commercially available flexible ureteroscopes functions. Continuous development of Avicenna Roboflex's ergonomics and surgeon user friendliness, and precise large intra-renal stone laser fragmentation, has increased flexible endoscope durability. The impact of these incremental improvements on fragmentation efficiency of different stone volumes, density and compositions are unknown. METHODS The Avicenna Roboflex allows user adjustable deflection scaling for greater tip control precision than is possible with manual flexible ureteroscope operation, where every 5 degrees of deflection movement deflects the tip 30 degrees. For optimal ergonomics, a central wheel for deflection mechanism control was eliminated, assigning this function to a new grooved thumb-wheel incorporated into the bulb of the right hand control. Moreover, a new universal remote pedal control unit allows remote laser and fluoroscopic activation control, while laser fiber advancement and retraction from the endoscope tip, irrigation flow rate with pulsed flush options, and the ability to influence renal respiratory excursion by adjusting an inflatable compression belt balloon, which are all possible from the Master Control Console, give the operator greater control of many different aspects of the surgical procedure. In this video, these capabilities of RA-RIRS treatment are demonstrated with the Avicenna Roboflex coupled to a Storz digital flexible ureteroscope, for upper tract stones of different volumes, densities and compositions, and for the first time, in an upper tract urothelial tumor. RESULTS Of sixty-eight consecutively treated patients, 62 met stone volume eligibility criteria (<4400mm3 ) for possible single session treatment, with 24% pre-stented. Stones had HU <1500, and were treated in <2 hours without complications. Non-contrast 3 months CT showed only one significant (4mm) stone residual needing a 2nd intervention in a triple phosphate infection stone, giving an overall 98% stone free rate. CONCLUSIONS The incremental improvements incorporated into the Avicenna Roboflex Master control console have increased operator control of key surgical procedural aspects, resulting in excellent single stage treatment outcomes for a wide range of stone compositions, while releasing precious operating room resources and avoiding endoscope breakage for additional cost savings. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1282 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Anup Patel More articles by this author Jan Klein More articles by this author Yasser Farahat More articles by this author Nida Zafer Tokatli More articles by this author Ahmet Sinan Kabakci More articles by this author Remzi Saglam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...