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Urolithiasis
Published in: Urolithiasis 1/2018

01-02-2018 | Invited Review

Robot-assisted flexible ureteroscopy: an update

Authors: Jens Rassweiler, Marcel Fiedler, Nikos Charalampogiannis, Ahmet Sinan Kabakci, Remzi Saglam, Jan-Thorsten Klein

Published in: Urolithiasis | Issue 1/2018

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Abstract

The role of flexible ureteroscopy (FURS) in the management of nephrolithiasis has increased due to the improved armamentarium. However, FURS still represents a challenging technique limiting its diffusion. Similar to previous experiences in laparoscopy, recently developed robotic devices may significantly compensate for the ergonomic deficiencies of FURS. Based on a short description of the history of robotic devices for laparoscopy, this article summarizes all current developments of robotic FURS. In 2008, robotic FURS was first reported using the Sensei–Magellan system designed for interventional cardiology. However, with this device the ureteroscope was only passively manipulated, which represented the main reason why this project has been discontinued after 18 clinical cases. Avicenna Roboflex™ was especially developed for FURS. It consists of a surgeon’s console and manipulator of a flexible ureterorenoscope. The console provides an adjustable seat with armrests and two manipulators of the endoscope: the right wheel enables deflection and the left horizontal joystick allows rotation as well as advancing and retracting the instrument. The speed of rotation and advancement can be regulated at the screen of the console. Using the IDEAL system for evaluation of new robotic devices, safety and efficacy of the system could be demonstrated in two multi-centric studies providing significant improved ergonomics for the surgeon (IDEAL stage 1 and 2). Future studies are necessary to determine the final role of robotic FURS.
Literature
1.
Rassweiler J, Bach T, Liatsikos E, Rane A, Richstone L, Teber D, Tewari A (2015) Future of minimally invasive surgery. In: Artibani W, Rassweiler J, Kaouk J, Menon M (eds) Minimally invasive surgery in urology, international consultation on minimally invasive surgery in Urology (ICUD-EAU 2015), pp 353–410 (ISBN: 978-9953-493-22-0)
2.
Rassweiler JJ, Teber D (2016) Advances in laparoscopic surgery in urology. Nat Rev Urol 13:387–399CrossRefPubMed
3.
4.
Rassweiler J, Rassweiler MC, Klein J (2016) New technology in ureteroscopy and percutaneous nephrolithotomy. Curr Opin Urol 26:95–106CrossRefPubMed
5.
6.
Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS Jr (2007) American Urological Association Education and Research, Inc; European Association of Urology. 2007 Guideline for the management of ureteral calculi. Eur Urol 52:1610–1631CrossRefPubMed
7.
8.
Breda A, Ogunyemi O, Leppert JT, Schulam PG (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intra-renal stones. Eur Urol 55:1190–1196CrossRefPubMed
9.
Rassweiler JJ, Knoll T, Köhrmann KU, McAteer JA, Lingeman JE, Cleveland RO, Bailey MR, Chaussy C (2011) Shock wave technology and application: an update. Eur Urol 59:784–796CrossRefPubMedPubMedCentral
10.
Patel A, Fuchs GJ (1997) Expanding the horizons of SWL through adjunctive use of retrograde intrarenal surgery: new techniques and indications. J Endourol 11:33–36CrossRefPubMed
11.
Knoll T, Jessen JP, Honeck P, Wendt-Nordahl G (2011) Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size. World J Urol 29:755–759CrossRefPubMed
12.
Holden T, Pedro RN, Hendlin K, Durfee W, Monga M (2008) Evidence-based instrumentation for flexible ureteroscopy: a review. J Endourol 22:1423–1426CrossRefPubMed
13.
14.
Monga M, Dretler SP, Landman J, Slaton JW, Conradie MC, Clayman RV (2002) Maximizing ureteroscope deflection: “play it straight”. Urology 60:902–905CrossRefPubMed
15.
Elkoushy MA, Andonian S (2011) Prevalence of orthopaedic complaints among endourologists are common and their compliance with radiation safety measures very important. J Endourol 25:1609–1613CrossRefPubMed
16.
Healy KA, Pak RW, Cleary RC, Colo-Herdman A, Bagley D (2011) Hand and wrist problems among endourologists are very common. J Endourol 25:1905–1920CrossRef
17.
Aron M, Haber GP, Desai MM, Gill IS (2007) Flexible robotics: a new paradigm. Curr Opin Urol 17:151–155CrossRefPubMed
18.
Desai MM, Aron M, Gill IS, Haber GP, Ukimura O, Kaouk JH, Stahler G, Barbagli O, Carlson C (2008) Flexible robotic retrograde renoscopy: description of novel robotic device and preliminary laboratory experience. Urology 72:42–46CrossRefPubMed
19.
Desai MM, Grover R, Aron M, Ganpule A, Joshi SS, Desai MR, Gill IS (2011) Robotic flexible ureteroscopy for renal calculi: initial clinical experience. J Urol 186:563–568CrossRefPubMed
20.
Saglam R, Kabakci AS, Koruk E, Tokatli Z (2012) How did we designed and improved a new Turkish robot for flexible ureterorenoscopy. J Endourol 26(suppl1):A275 (MP44-M12)
21.
Saglam R, Muslumanoglu AY, Tokatlı Z, Caşkurlu T, Sarica K, Taşçi A, Erkurt B, Süer E, Kabakci AS, Preminger G, Traxer O, Rassweiler JJ (2014) A new robot for flexible ureteroscopy: development and early clinical results (IDEAL Stage 1–2b). Eur Urol 66:1092–1100CrossRefPubMed
22.
Proietti S, Dragos L. Emiliani E, Buttice S, Talso M, Baghdadi M, Villa L, Doizi S, Giusti G, Traxer O (2017) Ureteroscopic skills with and without Roboflex Avicenna in the K-boxR simulator. Cent Eur J Urol 70:76–80
23.
Geavlete P, Saglam R, Georgescu D, Multescu R, Iordache V, Kabakci AS, Ene C, Geavlete B (2016) Robotic flexible ureteroscopy versus classis flexible ureteroscopy in renal stones: initial Romanian experience. Chirurgia 111:326–329PubMed
24.
Rassweiler J, Binder J, Frede T (2001) Robotic and telesurgery: will they change our future. Curr Opin Urol 11:309–320CrossRefPubMed
25.
Green PE, Piantanida TA, Hill JW et al (1991) Telepresence: dexterious procedures in a virtual operating field. Am Surg 57:192 (abstract)
26.
Satava RM (1992) Robotics, telepresence and virtual reality: a critical analysis of the future of surgery. Minim Invasive Ther Allied Technol 1:357–363
27.
Schurr MO, Buess G, Neisius B, Voges U (2000) Robotics and telemanipulation technologies for endoscopic surgery. A review of the ARTEMIS project. Surg Endosc 14:375–381CrossRefPubMed
28.
Reichenspurner H, Damiano RJ, Mack M, Boehm DH, Gulbins H, Detter C, Meiser B, Ellgass R, Reichart B (1999) Use of the voice-controlled surgical system ZEUS for endoscopic coronary bypass grafting. J Thorac Cardiovasc Surg 118:11–16CrossRefPubMed
29.
Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK (2001) Transatlantic robot-assisted telesurgery. Nature 413:379–380CrossRefPubMed
30.
Mohr FW, Falk V, Diegeler A, Autschbach R (1999) Computer-enhanced coronary artery surgery. J Thorac Cardiovasc Surg 117:1212–1215CrossRefPubMed
31.
Binder J, Kramer W (2001) Robotically assisted laparoscopic radical prostatectomy. BJU Int 87:408–410CrossRefPubMed
32.
Rassweiler J, Frede T, Seemann O, Stock C, Sentker L (2001) Telesurgical laparoscopic radical prostatectomy. Eur Urol 40:75–83CrossRefPubMed
33.
Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO, Vallancien G (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168:945–949CrossRefPubMed
34.
Bai R, Di Biase L, Valerrabano M, Lorgat F, Mlcochova H, Tilz R et. al (2012) Worldwide experience with the robotic navigation system in catheter ablation of atrial fibrillation: Methodology, efficacy and safety. J Cardiovasc Electrophysiol 23:820–826CrossRefPubMed
35.
McCulloch P, Cook JA, Altman DG, Heneghan C, Diener MK; IDEAL Group (2013) IDEAL framework for surgical innovation 1: the idea and development stages. BMJ 346:f3012CrossRefPubMedPubMedCentral
36.
Ergina PL, Barkun JS, McCulloch P, Cook JA, Altman DG; IDEAL Group (2013) IDEAL framework for surgical innovation 2: observational studies in the exploration and assessment stages. BMJ 346:f3011CrossRefPubMedPubMedCentral
37.
Klein JT, Fiedler M, Kabakci AS, Saglam R, Rassweiler J (2016) Multicenter phase II study of the clinical use of the Avicenna Roboflex URS robot in robotic retrograde intrarenal surgery. J Urol 195(Suppl.):116 abstract No. PD 18-08)
38.
39.
Sari E, Tepeler A, Yuruk E, Resorlu B, Akman T, Binbay M, Armagan A, Unsal A, Muslumanoglu AY (2013) Effect of the body mass index on outcomes of flexible ureterorenoscopy. Urolithiasis 41:499–504CrossRefPubMed
40.
Erkurt B, Caskurlu T, Atis G, Gurbuz C, Arikan O, Pelit ES, Altay A, Erdogan F, Yildirim A (2012) Treatment of renal stones with flexible ureteroscopy in preschool age children. J Endourol 26:625–629CrossRef
41.
Hellawell GO1, Mutch SJ, Thevendran G, Wells E, Morgan RJ (2005) Radiation exposure and the urologist: what are the risks?. J Urol 174:948–952CrossRefPubMed
42.
Kim KP1, Miller DL, Berrington de Gonzalez A, Balter S, Kleinerman RA, Ostroumova E, Simon SL, Linet MS (2012) Occupational radiation doses to operators performing fluoroscopically-guided procedures. Health Phys 103:80–99CrossRefPubMedPubMedCentral
43.
Carey RI, Gomez CS, Maurici G, Lynne CM, Leveillee RJ, Bird VG (2006) Frequency of ureteroscope damage seen at a tertiary care center. J Urol 176:607–610CrossRefPubMed
44.
Caddedu JA (2015) Comment on Saglam R, Muslumanoglu AY, Tokatlı Z et al (2014). A new robot for flexible ureteroscopy: development and early clinical results (IDEAL Stage 1-2b). Eur Urol 66:1092–1100 (J. Urol 193:1277)
45.
Dahm P, Sedrakyan A, McCulloch P (2014) Application of the IDEAL framework to robotic urologic surgery. Eur Urol 65:849–851CrossRefPubMed
Metadata
Title
Robot-assisted flexible ureteroscopy: an update
Authors
Jens Rassweiler
Marcel Fiedler
Nikos Charalampogiannis
Ahmet Sinan Kabakci
Remzi Saglam
Jan-Thorsten Klein
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
Urolithiasis / Issue 1/2018
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI
https://doi.org/10.1007/s00240-017-1024-8

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