Integrated Real-Time Digital Measurement During Ureteroscopic Procedures for Nephrolithiasis: A Workflow Feasibility Study

Taking measurement in every direction: Implicit scene representation for accurately estimating target dimensions under monocular endoscope

BACKGROUND AND OBJECTIVES

In endoscopy, measurement of target size can assist medical diagnosis. However, limited operating space, low image quality, and irregular target shape pose great challenges to traditional vision-based measurement methods.

METHODS

In this paper, we propose a novel approach to measure irregular target size under monocular endoscope using image rendering. Firstly synthesize virtual poses on the same main optical axis as known camera poses, and use implicit neural representation module that considers brightness and target boundaries to render images corresponding to virtual poses. Then, Swin-Unet and rotating calipers are utilized to obtain maximum pixel length of the target in image pairs with the same main optical axis. Finally, the similarity triangle relationship of the endoscopic imaging model is used to measure the size of the target.

RESULTS

The evaluation is conducted using renal stone fragments of patients which are placed in the kidney model and the isolated porcine kidney. The mean error of measurement is 0.12 mm.

CONCLUSIONS

The approached method can automatically measure object size within narrow body cavities in any visible direction. It improves the effectiveness and accuracy of measurement in limited endoscopic space.

Improving Staff Workflow in Urology Procedure Clinic Using the Model for Improvement

OBJECTIVE

To maximize procedure volume and minimize workflow inefficiency in our urological procedure clinic, we hypothesized that for staff (nurses/medical assistants) and patient teams, team workflow duration (TWD) (the time required to complete team duties for a single appointment) could be reduced by 50% with a targeted workflow intervention developed using the Model for Improvement and Plan-Do-Study-Act cycles. Workflow inefficiency leads to wasted time and workplace dissatisfaction, resulting in lost revenue due to low procedure volume and high staff turnover.

METHODS

A baseline time study was performed to measure TWD for clinical teams, including the front desk, physician, staff, and patient teams. Implementation of previously identified interventions was also recorded. A workflow intervention was developed in which staff duties were split among two roles: staffer and triager. TWD and intervention implementation were remeasured over six Plan-Do-Study-Act cycles. Semistructured interviews were conducted as a balance measure to assess impact on staff workflow and wellness.

RESULTS

Our workflow intervention resulted in a 44% and 42% reduction in staff and patient TWD, saving nearly 17 minutes per appointment on average. Thematic analysis revealed that time saved could be best used to protect lunch breaks and allow time to complete nonclinical duties such as patient calls, which had previously been performed after-hours.

CONCLUSION

Introduction of staffer and triager roles to staff workflow increased clinic efficiency by reducing workflow and procedure appointment duration. Time saved was used to increase procedure volume while also supporting staff wellness.

Single-use flexible ureteroscopes: how to choose and what is around the corner?

PURPOSE OF REVIEW

The pace of technology development with single-use endoscopy has led to a range of disposable ureteroscopes. We review the development of single-use scopes, deconstruct the basic design and functional characteristics of available devices, and discuss future directions for next-generation platforms.

RECENT FINDINGS

Currently available devices are differentiated on the basis of several core features. The optical, deflection and irrigation characteristics are marginally different with no device clearly superior in every category. Studies comparing single-use ureteroscopes in patients linked to outcomes are limited. The incorporation of next-generation technologies into these platforms include sensors to monitor intrarenal pressure and temperature, suction of fluid and fragments, and computer vision for artificial intelligence.

SUMMARY

Each ureteroscope has specific features that may be advantageous in different circumstances. Single-use devices could transform the ureteroscope from a visual conduit to a transformative surgical instrument that improves outcomes and reduces complications.