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Bai J, Chi Y, Shangguan T, Lin J, Ye Y, Huang J, Wen Y, Liu R, Chen R, Cai W, Chen J. Intrarenal pressure detection during flexible ureteroscopy with fiber optic pressure sensor system in porcine model. Sci Rep 2024; 14:9446. [PMID: 38658694 PMCID: PMC11043377 DOI: 10.1038/s41598-024-60080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
To validate the feasibility of a fiber-optic pressure sensor-based pressure measurement device for monitoring intrarenal pressure and to analyze the effects of ureteral acess sheath (UAS) type, surgical location, perfusion flow rate, and measurement location on intrarenal pressure (IRP). The measurement deviations and response times to transient pressure changes were compared between a fiber-optic pressure sensing device and a urodynamic device IRP in an in vitro porcine kidney and in a water tank. Finally, pressure measurements were performed in anesthetized female pigs using fiber-optic pressure sensing device with different UAS, different perfusion flow rates, and different surgical positions at different renal calyces and ureteropelvic junctions (UPJ). According to our operation, the result is fiber optic pressure sensing devices are highly accurate and sensitive. Under the same conditions, IRP varied among different renal calyces and UPJ (P < 0.05). IRP was lowest at 50 ml/min and highest at 150 ml/min (P < 0.05). Surgical position had a significant effect on IRP (P < 0.05). 12/14 Fr UAS had a lower IRP than 11/13 Fr UAS. Therefore fiber optic pressure sensing devices are more advantageous for IRP measurements. In ureteroscopy, the type of ureteral sheath, the surgical position, the perfusion flow rate, and the location of the measurement all affect the intrarenal pressure value.
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Affiliation(s)
- Junjie Bai
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yangjian Chi
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tong Shangguan
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lin
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yushi Ye
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianfeng Huang
- Department of Urology, Zhenghe County Hospital, Nanping, China
| | - Yahui Wen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong Liu
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ru Chen
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weizhong Cai
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China.
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Pauchard F, Bhojani N, Chew B, Ventimiglia E. How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives. Actas Urol Esp 2024; 48:42-51. [PMID: 37832846 DOI: 10.1016/j.acuroe.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. METHODS A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. RESULTS A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. CONCLUSIONS We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.
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Affiliation(s)
- F Pauchard
- Servicio de Urología, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - N Bhojani
- División de Urología, Universidad de Montreal, Montreal, QC, Canada
| | - B Chew
- Departamento de Ciencias Urológicas, Universidad de British Columbia, Vancouver, BC, Canada
| | - E Ventimiglia
- División de Oncología Experimental/Unidad de Urología, Instituto de Investigación Urológica (URI), IRCCS Hospital San Raffaele, Milán, Italy.
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Panthier F, Pauchard F, Traxer O. Retrograde intra renal surgery and safety: pressure and temperature. A systematic review. Curr Opin Urol 2023; 33:308-317. [PMID: 37140545 DOI: 10.1097/mou.0000000000001102] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE OF REVIEW Retrograde intra renal surgery (RIRS) with laser lithotripsy represents the gold-standard to treat renal stones up to 20 mm. Controlling intraoperative parameters such as intrarenal pressure (IRP) and temperature (IRT) is mandatory to avoid complications. This article reviews advances in IRP and IRT over the last 2 years. RECENT FINDINGS We conducted a PubMed/Embase search and reviewed publications that include temperature and pressure during RIRS. Thirty-four articles have been published which met the inclusion criteria. Regarding IRP, a consensus has emerged to control IRP during RIRS, in order to avoid (barotraumatic and septic) complications. Several monitoring devices are under evaluation but none of them are clinically approved for RIRS. Ureteral access sheath, low irrigation pressure and occupied working channel help to maintain a low IRP. Robotic systems and suction devices would improve IRP intraoperative management and monitoring. IRT determinants are the irrigation flow and laser settings. Low power settings(<20 W) with minimal irrigation flow (5-10 ml/min) are sufficient to maintain low IRT and allows continuous laser activation. SUMMARY Recent evidence suggests that IRP and IRT are closely related. IRP depends on inflow and outflow rates. Continuous monitoring would help to avoid surgical and infectious complications. IRT depends on the laser settings and the irrigation flow.
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Affiliation(s)
- Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
- Urology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
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Shu X, Hua P, Wang S, Zhang L, Xie L. Safety enhanced surgical robot for flexible ureteroscopy based on force feedback. Int J Med Robot 2022; 18:e2410. [PMID: 35439845 DOI: 10.1002/rcs.2410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although some robotic systems have been developed to improve conventional flexible ureteroscopy (FURS), a widely used intervention in urology, these robots rarely have a comprehensive force feedback function which is important for master-slave controlled surgical robots. METHODS Here, we design and fabricate a novel FURS robot with a comprehensive force feedback function. Moreover, to realize better force feedback, a neural network-based method is also demonstrated to estimate the interactive forces between the flexible ureteroscope and the environment. RESULTS We show that when teleoperating the flexible ureteroscope with our robot, the operator can accurately feel the obstruction if the interactive axial force or torque exceeds 1.2 N or 15.6 mN·m respectively. For bending movement, augmented force feedback greatly improves the accuracy of the operator's perception of obstruction. CONCLUSIONS The developed robotic system with force feedback is expected to improve the safety of robot-assisted FURS.
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Affiliation(s)
- Xiongpeng Shu
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Hua
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China
| | - Shuang Wang
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Zhang
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China
| | - Le Xie
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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Chen Y, Li C, Gao L, Lin L, Zheng L, Ke L, Chen J, Kuang R. Novel flexible vacuum-assisted ureteral access sheath(FV-UAS) can actively control intrarenal pressure and obtain a complete stone-free status. J Endourol 2022; 36:1143-1148. [PMID: 35243899 DOI: 10.1089/end.2022.0004] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare the safety and effectiveness of a novel flexible vacuum-assisted ureteral access sheath (FV-UAS) and traditional ureteral access sheath (UAS) in simulating retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS Amanometric model was established in porcine kidneys to observe the change inintrarenal pressure in the FV-UAS and traditional UAS groups at different irrigation fluid velocities of 30 ml/min, 50 ml/min, 80 ml/min, and 100 ml/min. Establish a kidney stone model (with 0.2 g, dry, ≤ 5 mm stones) to simulate RIRS. A total of 20 porcine kidneys wererandomly numbered from 1 to 20 (FV-UAS group, 1-10; traditional UAS group, 11-20). The stone volume clearance rate and operation time were compared between the two groups. [" Stone volume clearance rate= (1-(residual stone volume)/(preoperative stone volume))×100%" )]. Stones volume was obtained by computed tomography (CT) preoperatively and postoperatively. RESULTS FV-UAS can follow flexible ureteroscopy (f-URS) to cross the ureteropelvic junction (UPJ) and into the renal pelvis and calyces. FV-UAS can actively make intrarenal pressure (IRP) less than 10 cmH2O by adjusting the negative values atdifferent irrigation fluid velocities. The mean residual stone volume of the FV-UAS vs. traditional UAS groups was33.7 mm3 vs. 92.5 mm3 (P = 0.017). The mean stone volume clearance rates of the FV-UAS vs. traditional UAS groups were 98.5 % and95.9 %, respectively (P = 0.017). Seven cases achieved complete stone-free status in the FV-UAS group. All patients hadresidual fragments postoperatively in the traditional UAS group. CONCLUSIONS FV-UAS can follow f-URS to cross the UPJ and into the renal pelvis and calyces, avoiding the interference of UPJ in controlling IRP. FV-UAS can actively control the IRP to be reduced to the desired range by adjusting the negative value under any irrigation fluid velocity. FV-UAS close to the stone can achieve complete stone-free in RIRS.
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Affiliation(s)
- Yujun Chen
- Jiangxi Provincial People's Hospital, 159384, urology, Nanchang, Jiangxi, China;
| | - Chen Li
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Liang Gao
- Jiangxi Provincial People's Hospital, 159384, Nanchang, Jiangxi, China;
| | - Longhui Lin
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Liangliang Zheng
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Longlong Ke
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
| | - Jie Chen
- Jiangxi Provincial People's Hospital, 159384, Urology, 152 Aiguo Street,Nanchang City,China, Nanchang, China, 330006;
| | - Renrui Kuang
- Jiangxi Provincial People's Hospital, 159384, Department of Urology, Nanchang, Jiangxi, China;
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