Elsevier

Urology

Volume 72, Issue 1, July 2008, Pages 42-46
Urology

Endourology/MIS
Flexible Robotic Retrograde Renoscopy: Description of Novel Robotic Device and Preliminary Laboratory Experience

https://doi.org/10.1016/j.urology.2008.01.076Get rights and content

Objectives

To describe a novel flexible robotic system for performing retrograde intrarenal surgery.

Methods

Remote robotic flexible ureterorenoscopy was performed bilaterally in 5 acute swine (10 kidneys). A novel 14F robotic catheter system, which manipulated a passive optical fiberscope mounted on a remote catheter manipulator was used. The technical feasibility, efficiency, and reproducibility of accessing all calices were assessed. Additionally, laser lithotripsy of calculi and laser ablation of renal papillae were performed.

Results

The robotic catheter system could be introduced de novo in eight ureters; two ureters required balloon dilation. The ureteroscope could be successfully manipulated remotely into 83 (98%) of the 85 calices. The time required to inspect all calices within a given kidney decreased with experience from 15 minutes in the first kidney to 49 seconds in the last (mean 4.6 minutes). On a visual analog scale (1, worst to 10, best), the reproducibility of caliceal access was rated at 8, and instrument tip stability was rated at 10. A renal pelvic perforation constituted the solitary complication. Histologic examination of the ureter showed changes consistent with acute dilation without areas of necrosis.

Conclusions

A novel robotic catheter system is described for performing retrograde ureterorenoscopy. The potential advantages compared with conventional manual flexible ureterorenoscopy include an increased range of motion, instrument stability, and improved ergonomics. Ongoing refinement is likely to expand the role of this technology in retrograde intrarenal surgery in the near future.

Section snippets

Material and Methods

The procedure was performed bilaterally in 5 acute swine (weight 27 to 51 kg) after approval from the institutional animal care and use committee. The novel robotic catheter system (Fig. 1) comprises the following components: (a) surgeon console, including the LCD display and master input device, (b) steerable catheter system, (c) remote catheter manipulator, and (d) electronic rack.

Results

Balloon dilation of the intramural ureter was required in 2 of (20%) 10 kidneys to accommodate the robotic catheter system (Table 1). Of the 85 calices in the 10 kidneys, 83 (98%) could be adequately inspected with the flexible robotic system. Two lower pole minor calices, one in each kidney of animal 5 (weight 32 kg), could not be entered because of their small ostial size; however, a 3F basket could be passed into both these calices under direct endoscopic vision. The time required to inspect

Comment

The development and refinement of robotic technology has evolved into the recent development of a robotic flexible catheter manipulator (Sensei, Hansen Medical) that was initially and primarily developed for cardiac electrophysiologic application. This novel flexible robotic catheter system has the potential to further enhance the capabilities and efficiency of conventional flexible ureteroscopy. The Sensei remote robotic catheter system works on the principle of a master-slave robotic

Conclusions

We describe a novel robotic flexible catheter control system for remotely performing retrograde flexible ureterorenoscopy. Our initial experience in the acute porcine model was encouraging. Success was achieved in performing diagnostic ureteroscopy in all 10 kidneys tested and with the therapeutic maneuvers in the 6 kidneys tested. Additional refinement of this technology and planning of the initial clinical trial are currently underway.

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M. M. Desai is a consultant and stockholder in Hansen Medical; I. S. Gill is a consultant to, and stockholder in, Hansen Medical; and F. Moll, G. Stahler, C. Carlson, and C. Barbagli are employees of Hansen Medical, Mountain View, California.

This study was funded by Hansen Medical, Mountain View, California.

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