V9-10: ROBOTIC FLEXIBLE URETERORENOSCOPY WITH ROBOFLEX AVICENNA AND EARLY RESULTS OF MULTI INSTITUTIONAL TRIAL

Video

Introductions and Objectives
Flexible ureterorenoscopy which has been widely used in the treatment of kidney stones, has brought about some problems. It is a tiresome and exhausting procedure. Some studies have proven that these treatments have caused doctors to suffer from some problems, especially on their wrists and hands. We designed a robot which enables better treatment of the patient, protecting both the doctor and the flexible device. We studied a multi-centric trial to search the safety and effectivity of this new "Roboflex".

Methods
After inserting the access sheath in the conventional way, we are inserting the videoscope into the sheath then connecting the device to the manipulator of the robot. We seat the chair, adjust the arm support, choose the memory we saved before or produce a new memory for the next time. After finding the stone, we press the insert button in the laser fiber control part of the panel, we can adjust the length remotely. The rotation, insertion and retraction can be controlled by left handle. We can deflect the tip, with our right hand. The new wheel provides the user a very precise deflection of the tip. Attached water pump can be adjusted remotely to increase or decrease the flow rate to provide a better vision. Laser fiber can be remotely inserted or retracted. When necessary, pressing the button on the touch screen, the laser tip moves completely backward. Pressing the flush button to provide high fluid volume, with the adjustable pump of Roboflex, insertion of the laser fiber does not affect the fluid flow rate. We designed a prospective multicentric, clinical trial to search the safety and effectivity of the Roboflex, together with the urology clinics of 6 universities, 2 training hospitals and 2 private hospitals. The trial, based on the documents of the CT calculated the volume of the stones dusted or fragmented by Roboflex or manual fURS as mmcubic per minute.

Results
We successfully controlled all the functions of the flexible URS by using the robot and dusted/fragmented all of the stones. The early results of the trial from 36 patients, showed the following: Mean fragmented volume of the stones manually 36 mmcubic per minute and robotically 29 mmcubic per minute. Mean connection time of the device to the robot is 59 seconds. There was no damage of the fURS.

Conclusions
We found the robotic ureterorenoscopy safe and effective. We have been able to dust the stones precisely in a comparable time with manual flexible ureterorenoscopy, in an ergonomic position, far from the radiation source.

Funding: The Scientific and Technological Research Council of Turkey, Elmed Lithotripsy Systems