Abstract: PD16-02
Sources of Funding: none

Introduction

RIRS in larger stones and complex renal anatomy when done conventionally challenges a surgeon, causing fatigue leading to poor outcomes and stone free rates._x000D_ The Avicenna Robot addresses precision and surgeon fatigue. However, cost is a limiting factor._x000D_ _x000D_ 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._x000D_ -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._x000D_ - To assess surgeon fatigue and stone free rates(SFR) and the need for ancillary equipment and procedures._x000D_

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._x000D_ 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_x000D_ _x000D_ 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. _x000D_ SFR defined as residual fragments less than 3 mm was determined by CT scan 1 month or 3 months after surgery._x000D_

Results

All 100 cases involving 3 primary surgeons had successful RIRS by MEL technique with minimal fatigue._x000D_ Mean operative time for large stones 90.8 min _x000D_ Mean laser time 53.6 min._x000D_ 18% cases needed a basket to re-position stones._x000D_ Rate of sepsis 3%_x000D_ Average hospital stay was 2 days_x000D_ Scopes serviced: 2 _x000D_ No loss in scope functionality. Good visibility maintained.

Conclusions

_x000D_ Having reproduced the MEL technique for 100 cases with no added morbidity and good outcomes, we believe that our aims were successful._x000D_ We propose this technique as an alternative to standard RIRS ._x000D_ It definitely minimizes need for accessories is cost and surgeon effective,unless Avicenna becomes the cheapest alternative way forward in future._x000D_

Funding

none