V6-11: The new developments of the Robotic Assisted Retrograde Intra-Renal Surgery (RA-RIRS) with Avicenna Roboflex
Robotic flexible uretero-renoscopy (fURS) was first attempted by Desai M et al treating only a limited number of patients. Saglam R et al, developed the first robotic manipulator which can remotely control all functions of commercially available flexible endoscopes. Advantages of this new robotic master slave device for the treatment of kidney stones include improved precision with enhancement of stone fragmentation and dusting, while reducing operator fatigue and radiation exposure, and prolonging endoscope longevity through torque elimination.
The surgeon inserts a suitable ureteral access sheath, and the technician moves the Roboflex manipulator to the docking position. The fURS is introduced into the ureteral lumen through the access sheath manually, the instrument hand piece is coupled and locked into the special adaptor of the robotic arm. _x000D_ The fURS is manipulated with two joysticks. _x000D_ The right one enables precise deflection with a new integrated thumb-wheel. The precision of the deflection mechanism is very important. The Avicenna Roboflex allows the surgeon to control the endoscope tip by choosing the scaling precision of the thumb wheel. _x000D_ The left joystick stick enables rotation and in-and-out movements of the fURS. _x000D_ By using precise left and right control joysticks, the fURS is advanced into the kidney. The laser fiber actuator holding the laser fiber is inserted into the working channel of the fURS. Once the fire button is pressed, the tip of the laser fiber is automatically advanced to the nearest firing position. Further advancement of fiber can be performed by the operator using the “in-out” controls. _x000D_ _x000D_ The foot pedals of laser and fluoroscopy devices are remotely controlled with the new universal remote pedal control unit._x000D_ _x000D_ If high respiratory rate or excursion makes stone fragmentation difficult, some surgeons ask the anaesthetist to reduce tidal volume or request periods of apnea. However, an easier way with a simple, pump inflatable balloon compression device works equally well after consulting the anaesthetist for safety. _x000D_
The incremental improvements incorporated into the Avicenna Roboflex console described above, allow better operator control of key aspects of the procedure releasing expensive staff resources (cost savings), while improving both safety and efficacy for our patients. Together with elimination of radiation safety protocols and better comfort for the operator when treating large renal stones, efficiency can be improved especially when multiple such procedures are planned in a day’s operating.