V6-11 THE NEW DEVELOPMENTS OF THE ROBOTIC ASSISTED RETROGRADE INTRA-RENAL SURGERY (RA-RIRS) WITH AVICENNA ROBOFLEX

Abstract

You have accessJournal of UrologyUrolithiasis1 Apr 2016V6-11 THE NEW DEVELOPMENTS OF THE ROBOTIC ASSISTED RETROGRADE INTRA-RENAL SURGERY (RA-RIRS) WITH AVICENNA ROBOFLEX Jens Rassweiler, Kemal Sarica, Petrisor Geavlete, Nida Zafer Tokatli, Jan Klein, Olivier Traxer, AbdulQadir Al Zarooni, Yasser Farahat, David M. Hoenig, Guido Giusti, Volkan Tugcu, M. Abdurrahim Imamoglu, Ahmet Yaser Muslumanoglu, Murat Savas, Remzi Saglam, and Anup Patel Jens RassweilerJens Rassweiler More articles by this author , Kemal SaricaKemal Sarica More articles by this author , Petrisor GeavletePetrisor Geavlete More articles by this author , Nida Zafer TokatliNida Zafer Tokatli More articles by this author , Jan KleinJan Klein More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , AbdulQadir Al ZarooniAbdulQadir Al Zarooni More articles by this author , Yasser FarahatYasser Farahat More articles by this author , David M. HoenigDavid M. Hoenig More articles by this author , Guido GiustiGuido Giusti More articles by this author , Volkan TugcuVolkan Tugcu More articles by this author , M. Abdurrahim ImamogluM. Abdurrahim Imamoglu More articles by this author , Ahmet Yaser MuslumanogluAhmet Yaser Muslumanoglu More articles by this author , Murat SavasMurat Savas More articles by this author , Remzi SaglamRemzi Saglam More articles by this author , and Anup PatelAnup Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.411AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. METHODS 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. The fURS is manipulated with two joysticks. 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. The left joystick stick enables rotation and in-and-out movements of the fURS. 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. The foot pedals of laser and fluoroscopy devices are remotely controlled with the new universal remote pedal control unit. 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. RESULTS N/A CONCLUSIONS 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 f