Login to Access Video or Poster Abstract: V11-02
Sources of Funding: none

Introduction

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. _x000D_ The impact of these incremental improvements on fragmentation efficiency of different stone volumes, density and compositions are unknown._x000D_

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._x000D_ 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._x000D_

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 compos?t?ons, while releasing precious operating room resources and avoiding endoscope breakage for additional cost savings.

Funding

none