Urology & Kidney Disease News - Cleveland Clinic

28 Urology & Kidney Disease News
Robotic and Laparoscopic
Robotic Flexible Ureteroscopy and Laser Lithotripsy for
Renal Calculi: Initial Clinical Trial
*Mihir M. Desai, MD, Monish Aron, MD, Georges-Pascal
Haber, MD, Mahesh Desai, MD, Jihad Kaouk, MD,
*Inderbir S. Gill, MD, MCh
Retrograde uretero-renoscopy is routinely used for a variety
of diagnostic and therapeutic applications involving the
upper urinary tract. The increasing use of flexible ureterorenoscopy
for retrograde intra-renal surgery is the result of
advancements in flexible ureteroscope technology,
Holmium-YAG laser lithotripsy, and ureteroscope accessories
such as wires, baskets, and access sheaths. Significant
technologic developments with flexible ureteroscopy
include better deflection, improved optics, increased durability,
and miniaturization. Recently, a novel robotic
catheter system (Sensei, Hansen Medical) has been
developed for intra-cardiac electrophysiologic applications.
This robotic catheter system may enhance the capabilities
of conventional flexible uretero-renoscopy by providing a
stable, easily maneuverable, and ergonomically superior
platform. We modified software and catheter-guide configurations
from the original system designed for cardiac
applications and initially assessed the technical feasibility
of performing retrograde uretero-renoscopy in the acute
swine model.
Subsequent to our animal study, we performed the initial
clinical trial using the flexible robotic system in 18 select
patients with renal calculi. The study was performed in
collaboration with the Muljibhai Patel Urological Hospital
in India after obtaining IRB approval from both institutions
and informed consent. Inclusion criteria included renal
calculi 5-15 mm in size. All procedures were unilateral and
patients with co-existing ureteral calculi or obstruction,
uncontrolled infection, renal insufficiency, or solitary
kidney status were excluded from the study. Mean stone
Key Point:
The novel flexible robotic platform can be used safely and
effectively for retrograde intra-renal treatment of renal calculi
in select cases. Ongoing technical refinements are likely to
increase the incorporation of robotic technology in diagnostic
and therapeutic flexible endoscopy.
size was 11.9 mm. All patients were pre-stented for approximately
2 weeks. The robotic catheter system was introduced
into the renal collecting system manually under fluoroscopic
control over a guidewire. All intra-renal maneuvers
including stone relocation and fragmentation into 1-2 mm
particles were performed exclusively using remote robotic
control by the surgeon sitting at the console.
All procedures were technically successful without need for
conversion to manual ureteroscopy. Mean operative time
was 91 minutes, robot docking time was 7 minutes, and
stone localization time was 9 minutes. Mean visual analog
scale rating (1 worst, 10 best) of ease of stone localization
was 8.3, ease of maneuvering was 8.5, and ease of fragmentation
was 9.2 . Complete stone clearance was achieved in
56% of patients at 2 months based on CT scan, and 89% at 3
months based in IVU. One patient required secondary
ureteroscopy for residual stone. Complications included
pyelonephritis (2), pyrexia (1), and temporary limb paresis
(1). There was negligible fluid absorption based on calculation
of inflow and egress and ethanol fluid absorption.
For references, please email the editor.
*Mihir Desai, MD, and Inderbir Gill, MD, are consultants
and stockholders in Hansen Medical, which manufactures
Sensei. TM This article is written for educational purposes only
and as a convenience.