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Salah M, Laymon M, Gul T, Alnawasra H, Ibrahim M, Tallai B, Ebrahim M, Alrayashi M, Abdelkareem M, Al-Ansari A. Optimizing outcome reporting after robotic flexible ureteroscopy for management of renal calculi: Introducing the concept of tetrafecta. J Robot Surg 2024; 18:128. [PMID: 38492131 PMCID: PMC10944431 DOI: 10.1007/s11701-024-01858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
Robotic flexible ureteroscopy (RFURS) has shown encouraging results in terms of stone free rate (SFR) and better ergonomics compared to conventional FURS. However, few studies have reported its outcomes. The goal of this study was to report our initial results of RFURS, furthermore we proposed a novel metrics for composite outcome reporting named tetrafecta. A retrospective analysis of electronic records of 100 patients treated with RFURS for renal stones between 2019 till 2023 was performed. Tetrafecta criteria included, complete stone removal after a single treatment session, without auxiliary procedures, absence of high-grade complications (GIII-V) and same-day hospital discharge. Mean patient age and stone size were 40.7 ± 9.2 and 11.7 ± 5.8 mm, respectively. Median stone volume was 916 (421-12,235) mm3. Twenty-eight patients had multiple renal stones. Staghorn stones were seen in 12 patients. Preoperative DJ stent was fixed in 58 patients. Median operative time and stone treatment time were 116 min (97-148) and 37 (22-69) min. The median stone treatment efficiency (STE) was 21.6 (8.9-41.6). A strong positive correlation between stone volume and STE (R = 0.8, p < 0.0001). Overall, 73 patients were stone free after the initial treatment session while tetrafecta was achieved in 70 patients. Univariate analysis showed that the stone size (p = 0.008), acute infundibulopelvic angle (p = 0.023) and preoperative stenting (p = 0.017) had significant influence on achieving tetrafecta. Multivariate analysis identified preoperative stenting (OR 0.3, 95% CI 0.1-0.8, p = 0.019) as the only independent predictor of tetrafecta achievement. A comprehensive reporting methodology for reporting outcomes of RFURS is indicated for patient counseling and comparing different techniques. Tetrafecta was achieved in 70% of cases. Presence of significant residual stones ≥ 3mm was the leading cause of missing tetrafecta. Absence of preoperative stent was the only predictor of missing tetrafecta.
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Affiliation(s)
- Morshed Salah
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
- Department of Surgery-Urology, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Mahmoud Laymon
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tawiz Gul
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery-Urology, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Hossameldin Alnawasra
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Ibrahim
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bela Tallai
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Ebrahim
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maged Alrayashi
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abdelkareem
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al-Ansari
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery-Urology, College of Medicine, QU Health, Qatar University, Doha, Qatar
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AlShammari A, Benzouak T, Khogeer A, AlHaidey R, Arezki A, Fahmy N, Andonian S, Carrier S, Aubé-Peterkin M, Hamouche F. Understanding current ergonomics setup for urologists conducting anatomical endoscopic enucleation of the prostate surgeries: Survey analysis from the endourological society. Am J Surg 2024:S0002-9610(24)00157-0. [PMID: 38448320 DOI: 10.1016/j.amjsurg.2024.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Ensuring ergonomic posture and safety for surgeons is key to preventing work-related injuries and promoting sustained practice. We evaluated ergonomic aspects of Anatomic Endoscopic Enucleation of the Prostate (AEEP) and its relation to musculoskeletal injuries. METHOD A two-month online survey involving 119 Endourological Society members provided an in-depth analysis of AEEP practices and their musculoskeletal impacts. RESULTS The sample experienced general (65.5%), back (32.8%), neck (35.3%) and shoulder (37%) pain. Female AEEP surgeons reported greater back pain. Experience and age were inversely related to MSK injuries, and operative times over 2 h increased back pain. AEEP procedures predominantly involved sitting (86%) on backless stools (58%), with most surgeons wearing protective eyewear (75.6%) and using large resectoscopes (76.5%). Monitors were usually above eye-level (57%) and beyond 1 m (68.9%). CONCLUSION Musculoskeletal complaints are prevalent among AEEP endourologists. More awareness and further studies on risk factors are necessary to limit work-related injuries in urology.
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Affiliation(s)
- Ahmad AlShammari
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada.
| | - Tarek Benzouak
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Abdulghani Khogeer
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada; Department of Surgery, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan AlHaidey
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Adel Arezki
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Nader Fahmy
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Sero Andonian
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Serge Carrier
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Mélanie Aubé-Peterkin
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Fadl Hamouche
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
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Kaldany A, Patel HV, Shaw NM, Jones CP, Breyer BN. Ergonomics in Urology: Current Landscape and Future Directions. Urology 2024; 184:235-243. [PMID: 38160765 DOI: 10.1016/j.urology.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Optimal ergonomics are essential to improving clinical performance and longevity among urologists, as poor ergonomics can contribute to work-related injury and physician burnout. While a majority of urologists experience muscular injury throughout their career, women and trainees are disproportionately affected. These disparities are exacerbated by the lack of formal ergonomics education within urologic training programs. This review provides an overview of practical approaches to optimize ergonomics across working environments for urologists and trainees. We highlight intraoperative techniques and novel devices which have been shown to reduce work-related injury, and we identify knowledge gaps to guide future areas of ergonomic research.
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Affiliation(s)
- Alain Kaldany
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Hiren V Patel
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Nathan M Shaw
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC
| | - Charles P Jones
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA
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Talyshinskii A, Hameed BMZ, Naik N, Guliev B, Zhanbyrbekuly U, Khairley G, Juliebø-Jones P, Somani BK. Miniaturization of flexible ureteroscopes: a comparative trend analysis of 59 flexible ureteroscopes. Urolithiasis 2023; 52:16. [PMID: 38117336 DOI: 10.1007/s00240-023-01511-w] [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: 10/07/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
The purpose of this review is to analyze the trend in miniaturization of flexible ureteroscopes over the past decades, identify the advantages and disadvantages, and determine the correlation of individual parameters with release period. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time periods of < 2000 year, 2000-2009, 2010-2019, and 2020 onwards. The final review included only those instrument models for which data on tip size, overall shaft, working length and channel size had been determined. The correlation among features investigated as well as with release period was also determined. 59 models of flexible ureteroscopes (26 fiber optic and 33 digital scopes) were included. Among the different features investigated among fiber optic endoscopes, only the sizes of the distal tip and overall shaft positively correlated with each other. In contrast to their fiber optic counterparts, a strong positive correlation was observed between tip and channel sizes, whereas negative correlation was found between channel size and overall shaft size and working length of digital scopes. Only distal tip of fiber optic flexible ureteroscopes and overall shaft of digital endoscopes were significantly reduced over their evolution. With the development of technology, there has been an improvement of flexible ureteroscopes and one of the indicators of this trend is a decrease in their size. With a definite trend towards miniaturization over the past decades, a significant correlation was observed in tip size and overall shaft for fiber optic and digital endoscopes, respectively.
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Affiliation(s)
- Ali Talyshinskii
- Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Bakhman Guliev
- Department of Urology, Mariinsky Hospital, Saint Petersburg, Russia
| | | | - Gafour Khairley
- Department of Urology and Andrology, Astana Medical University, Astana, Kazakhstan
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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Gauhar V, Somani BK, Heng CT, Gauhar V, Chew BH, Sarica K, Teoh JYC, Castellani D, Saleem M, Traxer O. Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones. J Clin Med 2022; 11:jcm11195710. [PMID: 36233577 PMCID: PMC9570998 DOI: 10.3390/jcm11195710] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Retrograde intrarenal surgery (RIRS) is accepted as a primary modality for the management of renal stones up to 2 cm. The limitations of RIRS in larger volume stones include limited visualization due to the snow-globe effect and persistence of fragments that cannot be removed. We describe a new, simple, cost-effective modification that can be attached to any flexible ureteroscope which allows simultaneous/alternating suction and aspiration during/after laser lithotripsy using the scope as a conduit to remove the fragments or dust from the pelvicalyceal system called direct in-scope suction (DISS) technique. Between September 2020 and September 2021, 30 patients with kidney stones underwent RIRS with the DISS technique. They were compared with 28 patients who underwent RIRS with a 11Fr/13Fr suction ureteral access sheaths (SUASs) in the same period. RIRS and laser lithotripsy were carried out traditionally with a Holmium laser for the SUAS group or a thulium fiber laser for the DISS group. There was no difference in age, gender, and history of renal lithiasis between the two groups. Ten (40%) patients had multiple stones in the DISS groups, whilst there were no patients with multiple stones in the SUAS group. Median stone size was significantly higher in the DISS group [22.0 (18.0−28.8) vs. 13.0 (11.8−15.0) millimeters, p < 0.001]. Median surgical time was significantly longer in the DISS group [80.0 (60.0−100) minutes] as compared to the SUAS group [47.5 (41.5−60.3) minutes, p < 0.001]. Hospital stay was significantly shorter in the DISS group [1.00 (0.667−1.00) vs. 1.00 (1.00−2.00) days, p = 0.02]. Postoperative complications were minor, and there was no significant difference between the two groups. The incidence of residual fragments did not significantly differ between the two groups [10 (33.3%) in the DISS group vs. 10 (35.7%) in the SUAS group, p = 0.99] but 10 (33.3%) patients required a further RIRS for residual fragments in the DISS group, whilst only one (3.6%) patient in the SUAS group required a subsequent shock wave lithotripsy treatment. Our audit study highlighted that RIRS with DISS technique was feasible with an acceptable rate of retreatment as compared to RIRS with SUAS.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore 609606, Singapore
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK
| | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore 609606, Singapore
| | - Vishesh Gauhar
- Global Indian International School, Singapore 828649, Singapore
| | - Ben Hall Chew
- Department Urol Sci, University of British Columbia, Urologic Sciences, Vancouver, BC V6T 1Z4, Canada
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul 34010, Turkey
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 96H2+Q9, China
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-71-596-3367
| | - Mohammed Saleem
- Urology Research and Daycare Center, Apis Kidney Stone Institute, Mangalore 57502, India
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020 Paris, France
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Robotic Retrograde Intrarenal Surgery: A Journey from "Back to the Future". J Clin Med 2022; 11:jcm11185488. [PMID: 36143135 PMCID: PMC9501440 DOI: 10.3390/jcm11185488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
The introduction of robotics has revolutionized surgery. Robotic platforms have also recently been introduced in clinical practice specifically for flexible ureteroscopy. In this paper, we look at the robotic platforms currently available for flexible ureteroscopy, describing their advantages and limitations. The following robotic platforms are discussed: Roboflex Avicenna®, EasyUretero®, and ILY® robot. Finally, potential future advancements in this field are presented.
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